Utilization Management Registered Nurse - Remote Eligible

Utilization Management Nurse 2

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.

Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Required Qualifications

Active enhanced Registered Nurse (eNLC) license (RN) with no disciplinary action.

Ability to obtain multiple state registered nurse license.

Minimum three (3) years of Medical Surgery, Heart, Lung, maternity/obstetrics, or Critical Care Nursing experience required.

Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.

Intermediate to advanced knowledge of Microsoft Word, Outlook, and Excel, systems and platforms.

Ability to work independently under general instructions and with a team.

Preferred Qualifications

Bachelor’s degree.

Previous experience in prior authorization, claims, and/or utilization management in healthcare, health insurance, evaluating medical necessity and appropriateness of care.

Health Plan experience.

Previous Medicare/Medicaid experience a plus.

Bilingual is a plus.

Workstyle: Remote work at home.

Location: Must reside in a state that participates in the enhanced nurse licensure, (eNLC).

Schedule: Monday through Friday 8:00 AM to 5:00 PM Eastern, with ability to work over-time, weekends as needed to support business needs.

Travel: Less than 5%.

Additional Information: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Scheduled Weekly Hours: 40

Pay Range: $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, "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.

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.