utilization management registered nurse

Humana

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 Become a part of our caring community
 
 
 
 The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
 
 
 
 As a Utilization Management Registered Nurse
 
 
 
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 You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
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 Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers
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 You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
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 You will communicate with providers, members, or other parties to facilitate care and treatment.
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 You will help deliver coordinated care for our members
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 You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
 
 
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 Required Qualifications
 
 
 
 
 Use your skills to make an impact
 
 
 
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 Must hold Compact Registered Nurse (RN) license in your state of residence
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 Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
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 Must be passionate about contributing to an organization focused on improving consumer experiences
 
 
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 Preferred Qualifications
 
 
 
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 Previous experience in utilization management/utilization review for a health plan or acute care setting
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 Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
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 Experience working in a fully remote, metrics-focused role
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 Experience as an MDS Coordinator or discharge planner in an acute care setting
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 Experience as an RN for a Medicare Certified Home Health agency
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 Health Plan or Medicare / Medicaid Experience
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 Call center or triage experience
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 BSN or bachelor's degree in a related field
 
 
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 Additional Information
 
 
 
 Work-at-Home Information
 
 
 
 To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
 
 
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 At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
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 Satellite, cellular and microwave connection can be used only if approved by leadership.
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 Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
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 Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
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 Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
 
 
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 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 
 Scheduled Weekly Hours
 
 
 
 40
 
 
 
 Pay Range
 
 
 
 The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
 
 
 $71,100 - $97,800 per year
 
 
 This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
 
 
 
 Description Of Benefits
 
 
 
 Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
 
 
 
 About Us
 
 
 
 About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
 
 
 
 Equal Opportunity Employer
 
 
 
 It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
</div>

Utilization Management Registered Nurse

DataAnnotation

<div>
 
 About The Job
 
 
 
 We are looking for an existing Nurse to help train AI models.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Advantages Of Contracting With Us
 
 
 
 <ul>
 <li>
 You'll be able to choose which projects you want to work on and when
 </li>
 <li>
 You work on your own schedule, on your own computer, from the comfort of your own home
 </li>
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 Projects are paid hourly starting at $50-$60 USD per hour, with bonus rates available on some projects
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
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 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
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 Evaluate the quality produced by AI models for correctness and performance
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 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
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 A current or in progress medical degree
 
 
 </li>
 </ul>
 Note: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 #medicine
</div>

Nurse - AI Trainer

<div>
 
 About The Job
 
 
 
 We are looking for an existing Respiratory Therapist to help train AI models.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Advantages Of Contracting With Us
 
 
 
 <ul>
 <li>
 You'll be able to choose which projects you want to work on and when
 </li>
 <li>
 You work on your own schedule, on your own computer, from the comfort of your own home
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonus rates available on some projects
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Note: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 #medicine
</div>

Respiratory Therapist - AI Trainer

Explore 3+ Utilization management registered nurse in Delaware this June. Find roles across top companies and apply now to boost your career.

3 utilization management registered nurse jobs In Delaware

Utilization Management Registered Nurse

Nurse - AI Trainer

Respiratory Therapist - AI Trainer