Utilization Management Registered Nurse

🔥 0 minutes ago

🏈 Alabama, Arizona, +31 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟢 Junior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Interpret and support the coordination, documentation, and communication of medical services and benefit administration determinations • Use established medical criteria and information from attending physicians and other care providers to make determinations • Complete request determinations within established processing time frames • Communicate with providers, members, and other parties to facilitate care and treatment • Help deliver coordinated care for members • Support post-acute care services including Skilled Nursing Facility, Home Health, and Durable Medical Equipment • Understand department, segment, and organizational strategy and operating goals • Report to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team

🎯 Requirements

• Must hold Compact Registered Nurse (RN) license in your state of residence • Greater than one year of clinical experience as an RN in a hospital, SNF, Home Health, or acute care setting • Must be passionate about contributing to an organization focused on improving consumer experiences • Minimum internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Must meet Florida Level 2 background screening requirements when applying from a Florida work location • Preferred: Previous experience in utilization management/utilization review for a health plan or acute care setting • Preferred: Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or InterQual • Preferred: Experience working in a fully remote, metrics-focused role • Preferred: Experience as an MDS Coordinator or discharge planner in an acute care setting • Preferred: Experience as an RN for a Medicare Certified Home Health agency • Preferred: Health Plan or Medicare/Medicaid experience • Preferred: Call center or triage experience • Preferred: BSN or bachelor's degree in a related field

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Internet expense payment for employees working from home in California, Illinois, Montana, or South Dakota • Telephone equipment appropriate to business requirements • Remote work arrangement • Occasional travel to Humana offices for training or meetings