RN - Remote Utilization Management Nurse - Medicare - SE Region; Compact license

Become a part of our caring community and help us put health first

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 Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning, including assistance with social determinants and closing gaps.
• 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, requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

• Licensed Registered Nurse (RN) with compact license with no disciplinary action or in process of obtaining compact license.
• 3–5 years of Clinical Nursing experience required; preferably Emergency Room or critical care.
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and with a team.
• Must have the ability to provide a high‑speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10 mbs download × 1 mbs upload) is required.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

• Education:
  
  BSN or Bachelor's degree in a related field.
• Health Plan experience.
• Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred.
• Previous Medicare experience a plus.
• Milliman MCG experience preferred.

Hours: 8am‑5pm EST

Work‑At‑Home Requirements:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the states of California, Illinois, Montana, or South Dakota will receive a bi‑weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Humana values personal identity protection
. Please be aware that 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  with instructions on how to add the information into your official application on Humana’s secure website.

Scheduled Weekly

Hours:

40

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.
$69,800 – $96,200 per year.
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental…