RN, Manager, Utilization Management Nursing - Remote Eligible

Become a Part of Our Caring Community and Help Us Put Health First

The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals.

Responsibilities include:

• Providing leadership and oversight of the physical health utilization management (UM) staff in daily operations.
• Using clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
• Hiring, training, coaching, counseling, and evaluating the performance of direct reports.
• Implementing and maintaining processes that are compliant with the Michigan Department of Health and Human Services (MDHHS) and National Committee for Quality Assurance (NCQA) guidelines.
• Working collaboratively with UM leadership to assess and mitigate inefficiencies and provide solutions to improve clinical outcomes.
• Collecting and analyzing data as necessary to drive operational metrics and associate performance.
• Coordinating and communicating with Providers, Members, or other parties to facilitate optimal care and treatment.
• Making decisions that are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Facilitating cross-departmental collaboration and conducting briefings and area meetings; maintaining frequent contact with other managers across functional areas.

Required Qualifications:

• An active, unrestricted Registered Nurse (RN) license in the state of Michigan.
• Previous experience in utilization management and/or utilization review.
• Minimum of two (2) years of proven experience in management or leadership role.
• Prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.
• Ability to work independently under general instructions and with a team.

Preferred Qualifications:

• BSN, bachelor's degree in health services, healthcare administration, or business administration.

Additional Information:

• Workstyle: This is a remote position.
• Travel: Up to 25% travel may be required to attend onsite team engagement meetings at Humana's Detroit, Michigan office, as well as conferences and events both within and outside the state of Michigan.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)
• Direct Reports: Up to 15 associates.

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:

• 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.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• 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.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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: $94,900 - $130,500 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, "Humana") 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.

Application Deadline: 12-26-2025

About Us: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.