SNF Utilization Management RN
RemotePosted 3 weeks ago
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Upload Your ResumeAbout This Role
This Utilization Management Nurse 2 role supports the coordination, documentation, and communication of medical services and benefit determinations using clinical nursing skills. The position requires independent critical thinking to ensure appropriate treatment and care for members.
Responsibilities
- Utilize clinical nursing skills to coordinate, document, and communicate medical services and benefit determinations
- Interpret criteria, policies, and procedures to provide optimal care and treatment for members
- Coordinate and communicate with providers, members, or other parties to facilitate care
- Make decisions regarding own work methods, often in ambiguous situations
- Follow established guidelines and procedures
Requirements
- Licensed Registered Nurse (RN) with no disciplinary action
- Compact License
- Greater than one year of clinical experience in an RN role in acute care setting
- Comprehensive knowledge of Microsoft Word, Outlook, and Excel
- Ability to work independently and with a team
- High-speed DSL or cable modem for home office (Satellite and Wireless Internet not allowed)
- Minimum internet speed of 25mbs download x 10mbs upload
- Dedicated office space lacking ongoing interruptions
Qualifications
- Greater than one year of clinical experience in an RN role in acute care setting, with preference for specialty areas such as critical care, emergency room, or trauma units.
Nice to Have
- BSN or Bachelor's degree in a related field
- Three or more years of clinical experience in an acute care setting with preference for critical care, emergency room, or trauma units
- Experience as an MDS Coordinator or discharge planner in an acute care setting
- Previous experience in utilization management/utilization review for a health plan or acute care setting
- Compact license PLUS a single state RN Licensure in CA, HI, NV, or OR
- Health Plan experience
- Previous Medicare/Medicaid Experience
- Call center or triage experience
Skills
* Required skills
Benefits
About Humana
CenterWell Home Health specializes in personalized, comprehensive home care for patients managing chronic conditions or recovering from injury, illness, surgery, or hospitalization. CenterWell, a Humana company, is focused on whole-person health, providing senior-focused primary care, home health se...