Humana
Utilization Management Nurse - Home Solutions - Compact RN Required
Humana, New York, New York, United States
Join the Humana team as a Utilization Management Nurse - Home Solutions. This full‑time, remote telephonic role requires a compact RN license and focuses on ensuring value‑based home care.
Base pay range $71,100 – $97,800 per year
Job Overview The Utilization Management Nurse 2 supports the coordination, documentation, and communication of medical services and benefit administration determinations. Working on the OneHome/Home Solutions UM Team, you will leverage your clinical knowledge, communication skills, and independent critical thinking to facilitate optimal member care at home.
Responsibilities
Interpret and independently determine appropriate courses of action for care coordination.
Coordinate and communicate with providers, members, and other parties to facilitate optimal member care and treatment.
Ensure fully coordinated care at home for members.
Apply clinical knowledge to support value‑based care for members who desire to heal at home.
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 a compact license.
3+ years of progressive clinical experience, including direct patient care of the geriatric population.
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.
≥2 years of home health or utilization management experience.
Experience in a managed‑care setting or health‑plan experience.
Experience with CGX.
Work‑At‑Home Requirements
High‑speed DSL or cable modem. Satellite and wireless internet are not allowed.
Minimum internet speed of 25 mbps download and 10 mbps upload.
A dedicated office space with minimal interruptions for HIPAA compliance.
Schedule Monday – Friday, 8:00 am – 5:00 pm Eastern Standard Time (40 hours/week).
Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.
Equal Opportunity Employer Humana is an equal opportunity employer. No discrimination on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA.
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Base pay range $71,100 – $97,800 per year
Job Overview The Utilization Management Nurse 2 supports the coordination, documentation, and communication of medical services and benefit administration determinations. Working on the OneHome/Home Solutions UM Team, you will leverage your clinical knowledge, communication skills, and independent critical thinking to facilitate optimal member care at home.
Responsibilities
Interpret and independently determine appropriate courses of action for care coordination.
Coordinate and communicate with providers, members, and other parties to facilitate optimal member care and treatment.
Ensure fully coordinated care at home for members.
Apply clinical knowledge to support value‑based care for members who desire to heal at home.
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 a compact license.
3+ years of progressive clinical experience, including direct patient care of the geriatric population.
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.
≥2 years of home health or utilization management experience.
Experience in a managed‑care setting or health‑plan experience.
Experience with CGX.
Work‑At‑Home Requirements
High‑speed DSL or cable modem. Satellite and wireless internet are not allowed.
Minimum internet speed of 25 mbps download and 10 mbps upload.
A dedicated office space with minimal interruptions for HIPAA compliance.
Schedule Monday – Friday, 8:00 am – 5:00 pm Eastern Standard Time (40 hours/week).
Benefits Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.
Equal Opportunity Employer Humana is an equal opportunity employer. No discrimination on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA.
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