Humana
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Utilization Management Registered Nurse
role at
Humana
Base Pay Range $71,100.00/yr – $97,800.00/yr
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 role requires interpretation and independent determination of appropriate courses of action, and involves medical necessity reviews for Medicaid claims and provider disputes.
Role Overview
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, with minimal direction and guidance when needed; follows established guidelines/procedures.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license with no disciplinary action in the state where you reside, and ability to obtain multiple state RN licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings—including medical‑surgical, cardiology, pulmonology, maternity/obstetrics, or critical care nursing.
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, provider disputes, and/or utilization management in healthcare, health insurance, evaluating medical necessity and appropriateness of care.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience a plus.
Additional Information 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 in most time zones, with ability to work overtime and weekends as needed to support business needs.
Training:
The training program will span approximately four weeks, with sessions scheduled from 8:00 AM to 5:00 PM Eastern Time. Additional virtual training opportunities will also be provided.
Travel:
Less than 5%
Internet Statement
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert:
Humana values personal identity protection. 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.
Interview Format:
Hiring process utilizes the interviewing technology HireVue to enhance our hiring and decision-making ability.
Schedule 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 Includes eligibility for a bonus incentive plan based on company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being. Benefits include medical, dental and vision coverage, a 401(k) retirement savings plan, paid time off (including 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 teammates, customers and the 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.
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. Humana also adheres to affirmative action and non‑discrimination policies in compliance with Section 503 of the Rehabilitation Act and VEVRAA.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Insurance
#J-18808-Ljbffr
Utilization Management Registered Nurse
role at
Humana
Base Pay Range $71,100.00/yr – $97,800.00/yr
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 role requires interpretation and independent determination of appropriate courses of action, and involves medical necessity reviews for Medicaid claims and provider disputes.
Role Overview
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, with minimal direction and guidance when needed; follows established guidelines/procedures.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license with no disciplinary action in the state where you reside, and ability to obtain multiple state RN licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings—including medical‑surgical, cardiology, pulmonology, maternity/obstetrics, or critical care nursing.
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, provider disputes, and/or utilization management in healthcare, health insurance, evaluating medical necessity and appropriateness of care.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience a plus.
Additional Information 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 in most time zones, with ability to work overtime and weekends as needed to support business needs.
Training:
The training program will span approximately four weeks, with sessions scheduled from 8:00 AM to 5:00 PM Eastern Time. Additional virtual training opportunities will also be provided.
Travel:
Less than 5%
Internet Statement
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert:
Humana values personal identity protection. 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.
Interview Format:
Hiring process utilizes the interviewing technology HireVue to enhance our hiring and decision-making ability.
Schedule 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 Includes eligibility for a bonus incentive plan based on company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being. Benefits include medical, dental and vision coverage, a 401(k) retirement savings plan, paid time off (including 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 teammates, customers and the 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.
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. Humana also adheres to affirmative action and non‑discrimination policies in compliance with Section 503 of the Rehabilitation Act and VEVRAA.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Insurance
#J-18808-Ljbffr