Utilization Management Nurse

About This Role

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. This role is ideal for experienced nurses who can work independently and make critical decisions regarding patient care.

• Pay
  : $71,100 - $97,800/year
• Location
  :
  Remote, LA
• Department/Unit
  :
  Care Management
• Schedule
  :
  Full-time, Monday through Friday, 8:00 AM to 5:00 PM Central Time
• Residency
  :
  Must reside in the state of Louisiana

• Utilize clinical knowledge and communication skills to interpret criteria, policies, and procedures.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Support the Medicaid Care Management Team.
• Participate in training programs spanning approximately four to six weeks.

Education:

• RN License in the state of Louisiana required

Experience:

• 3+ years of varied RN nursing experience
• Experience in Utilization Management Review and/or Prior Authorization preferred
• Previous Medicare/Medicaid experience a plus

Licenses &

Certifications:

• Current RN License in Louisiana
• Compact Nursing License preferred

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off, including personal holidays and parental leave
• Short-term and long-term disability
• Life insurance

Humana Inc. is a leading U.S. healthcare company. Through their insurance services and healthcare services, they strive to make it easier for millions of people to achieve their best health, delivering the care and service needed when it is needed.