Humana
Job Title
Utilization Management Registered Nurse
Base Pay Range $71,100.00/yr - $97,800.00/yr
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, and requires minimal direction.
Conducts medical necessity reviews for Medicaid claims and provider disputes.
Responsibilities
Utilize clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determinations.
Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
Work independently under general instructions and collaborate with a team.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license in the state of residence, with the ability to obtain multiple state licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings.
Intermediate to advanced knowledge of Microsoft Word, Outlook, and Excel.
Preferred Qualifications
Bachelor’s degree.
Experience in prior authorization, claims, provider disputes, or utilization management.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience.
Workstyle & Location Remote work at home. Must reside in a state that participates in the enhanced nurse licensure program (eNLC).
Schedule Monday through Friday, 8:00 AM – 5:00 PM (most time zones). Availability to work overtime and weekends as needed.
Training Four‑week training program from 8:00 AM to 5:00 PM Eastern Time, with additional virtual sessions.
Travel Less than 5%.
Benefits Humana offers medical, dental & vision benefits; a 401(k) retirement plan; paid time off, company holidays, volunteer time; short‑term & long‑term disability; life insurance.
Equal Opportunity Employer Humana is an equal‑opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
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Base Pay Range $71,100.00/yr - $97,800.00/yr
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, and requires minimal direction.
Conducts medical necessity reviews for Medicaid claims and provider disputes.
Responsibilities
Utilize clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determinations.
Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
Work independently under general instructions and collaborate with a team.
Required Qualifications
Active unrestricted Compact Registered Nurse (RN) license in the state of residence, with the ability to obtain multiple state licenses.
At least three (3) years of clinical nursing experience, ideally in acute care, skilled nursing, or rehabilitation settings.
Intermediate to advanced knowledge of Microsoft Word, Outlook, and Excel.
Preferred Qualifications
Bachelor’s degree.
Experience in prior authorization, claims, provider disputes, or utilization management.
Health Plan/MCO experience.
Previous Medicare/Medicaid experience.
Workstyle & Location Remote work at home. Must reside in a state that participates in the enhanced nurse licensure program (eNLC).
Schedule Monday through Friday, 8:00 AM – 5:00 PM (most time zones). Availability to work overtime and weekends as needed.
Training Four‑week training program from 8:00 AM to 5:00 PM Eastern Time, with additional virtual sessions.
Travel Less than 5%.
Benefits Humana offers medical, dental & vision benefits; a 401(k) retirement plan; paid time off, company holidays, volunteer time; short‑term & long‑term disability; life insurance.
Equal Opportunity Employer Humana is an equal‑opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
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