Humana
Utilization Management Nurse - Home Solutions - Compact RN Required
Humana, Phoenix, Arizona, United States
Utilization Management Nurse - Home Solutions - Compact RN Required
Humana invites applications for this full‑time, remote, telephonic position, providing care coordination and utilization management for home solutions.
Base pay range $71,100.00/yr – $97,800.00/yr
Shift Monday – Friday, 8:00 AM – 5:00 PM Eastern Standard Time (40 hours/week)
Responsibilities Utilization Management Nurse 2 uses clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determ. This role requires interpretation and independent determination of appropriate courses of action, ensuring value‑based care for members who heal at home.
Coordinates and communicates with providers, members, and other parties to facilitate optimal member care.
Works independently while following established guidelines, processes, and procedures.
Applies clinical knowledge and critical thinking to improve patient outcomes.
Collaborates with internal and external stakeholders.
Required Qualifications
Associate Degree in Nursing.
Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
Valid compact license or eligibility to upgrade to compact licensure.
Three or more years of progressive and varying clinical experience, including geriatric population.
Effective telephonic and virtual communication skills.
Proficient with Microsoft Word, Outlook and Excel.
Ability to work independently under general instructions and within a team.
Preferred Qualifications
Bachelor’s degree.
Two years or more of home health or utilization management experience.
Experience in a managed care or health plan setting.
CGX experience.
Work‑At‑Home Requirements
High‑speed DSL or cable modem (satellite or wireless Internet not allowed).
Minimum download speed 25 mbps and upload speed 10 mbps.
Dedicated office space free of interruptions to protect PHI / HIPAA information.
Travel Occasional travel to Humana offices for training or meetings may be required.
Description Of Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, short‑term and long‑term disability, and life insurance.
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 also takes affirmative action to employ and advance individuals with disability or protected veteran status, focusing on valid job requirements.
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Base pay range $71,100.00/yr – $97,800.00/yr
Shift Monday – Friday, 8:00 AM – 5:00 PM Eastern Standard Time (40 hours/week)
Responsibilities Utilization Management Nurse 2 uses clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determ. This role requires interpretation and independent determination of appropriate courses of action, ensuring value‑based care for members who heal at home.
Coordinates and communicates with providers, members, and other parties to facilitate optimal member care.
Works independently while following established guidelines, processes, and procedures.
Applies clinical knowledge and critical thinking to improve patient outcomes.
Collaborates with internal and external stakeholders.
Required Qualifications
Associate Degree in Nursing.
Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
Valid compact license or eligibility to upgrade to compact licensure.
Three or more years of progressive and varying clinical experience, including geriatric population.
Effective telephonic and virtual communication skills.
Proficient with Microsoft Word, Outlook and Excel.
Ability to work independently under general instructions and within a team.
Preferred Qualifications
Bachelor’s degree.
Two years or more of home health or utilization management experience.
Experience in a managed care or health plan setting.
CGX experience.
Work‑At‑Home Requirements
High‑speed DSL or cable modem (satellite or wireless Internet not allowed).
Minimum download speed 25 mbps and upload speed 10 mbps.
Dedicated office space free of interruptions to protect PHI / HIPAA information.
Travel Occasional travel to Humana offices for training or meetings may be required.
Description Of Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, short‑term and long‑term disability, and life insurance.
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 also takes affirmative action to employ and advance individuals with disability or protected veteran status, focusing on valid job requirements.
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