Remote Clinical Implementation Lead, Utilization Management

Humana Inc; Kentucky; Hybrid; USD 112,000 - 143,000; Full time

Job summary

Humana Inc. is seeking a Lead Clinical Implementation Consultant to translate utilization management requirements into scalable workflows and technology solutions across clinical decision support, ePA, and claims operations.

The role collaborates with Medical Directors, Referrals and Authorizations, Claims, Product, and Technology to implement new clinical services and codes, while improving provider experience, operational efficiency, and clinical accuracy.

Qualifications

• Active, unrestricted RN license.
• Bachelor's degree in nursing; Master’s preferred.
• 7+ years in Utilization Management, Managed Care, Clinical Operations, or related healthcare operations.
• Applicable State licensure in field of study.
• Passionate about improving consumer experiences.

Responsibilities

• Govern new clinical procedure codes and ensure consistent implementation across systems.
• Lead CareWebQI and ePA initiatives to improve workflows and automate processes.
• Coordinate with Medical Directors, Claims, Referrals/Authorizations, Technology, and Product for aligned decision-making.

Skills

Utilization management

Clinical operations

Healthcare operations

Leadership

RN licensure

Education

Bachelor's degree in nursing

Master's degree in nursing

Tools

CareWebQI

ePA solutions

Job description

Humana Inc. is seeking a Lead Clinical Implementation Consultant to translate utilization management requirements into scalable workflows and technology solutions across clinical decision support, ePA, and claims operations.

The role collaborates with Medical Directors, Referrals and Authorizations, Claims, Product, and Technology to implement new clinical services and codes, while improving provider experience, operational efficiency, and clinical accuracy.