Humana is looking for a Utilization Management Nurse to utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. You will be part of our caring community, committed to putting health first.
What You'll Do
- Utilize clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
- Use clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures.
- Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
- Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction.
- Follow established guidelines and procedures.
What We're Looking For
- Licensed Registered Nurse (RN) Compact license, with no disciplinary action
- 3 years of prior clinical experience as an RN
- Proven ability to work independently, taking initiative to utilize resources for decision making
- Computer proficiency: comfortable working with and on computers, within multiple systems simultaneously, including efficient use of Microsoft products (Word, Excel, etc.)
- Strong verbal and written communication skills
- Excellent organizational and time management skills
Nice to Have
- Outpatient or inpatient Utilization Management experience
- Health Plan/Insurance experience
- Experience with Medicare/Medicaid regulations
- Bachelor’s degree in nursing (BSN)
- Experience working in a virtual environment
- Bilingual in Spanish/English
Technical Stack
- Microsoft products (Word, Excel)
Benefits & Compensation
- Compensation: $71,100 - $97,800 per year
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
Work Mode
This is a remote position open to candidates in any time zone.
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.
