Utilization Management Appeals Nurse
Humana(1 month ago)
About this role
The Utilization Management Nurse 2 supports coordination, documentation, and communication of medical services and benefit administration determinations for Medicare Part C grievance and appeals cases. The role prepares case summaries for review by Humana Medicare Medical Directors, reviews medical documentation and prior determinations, and researches claims and benefits. The position collaborates with internal teams, vendors, and medical directors to improve member outcomes and operational processes.
Required Skills
- Case Preparation
- Appeals Review
- Medical Documentation
- Claims Research
- Provider Outreach
- Utilization Management
- Medicare Knowledge
- Documentation Systems
- Time Management
- Collaboration
Qualifications
- RN License
- BSN
About Humana
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