Remote Utilization Management Lead – RN

Humana Inc; Northern (KY); On-site; USD 95,000 - 131,000; Full time

Benefits offered by this job

Bonus eligibility

Remote work from home

Job summary

Humana Inc. is seeking an Utilization Management Manager to lead a remote Wisconsin-based team responsible for medical necessity reviews and prior authorizations for Medicare and Medicaid services.

You will drive quality, compliance, and operational performance while supporting providers and members. The role requires an RN license (WI or compact), 3+ years in utilization management, and 2+ years of leadership experience.

Qualifications

• Active, unrestricted RN license in Wisconsin or a compact state is required.
• Minimum 3+ years in utilization management with leadership experience.
• Bachelor's degree and strong analytical/communication skills are required.

Responsibilities

• Lead nurses and support staff in utilization management and prior authorization.
• Oversee medical necessity and level-of-care reviews across services.
• Ensure compliant, accurate authorization decisions per regulations.
• Monitor team productivity, quality, and service levels with metrics.
• Educate providers on processes and guidelines; drive process improvement.
• Manage resources and collaborate with cross-functional partners.

Skills

Active RN license (WI or compact)

Utilization management experience

Leadership experience

Excel macros / advanced Excel

Education

Bachelor's degree

Tools

Microsoft Excel

Job description

Humana Inc. is seeking an Utilization Management Manager to lead a remote Wisconsin-based team responsible for medical necessity reviews and prior authorizations for Medicare and Medicaid services.

You will drive quality, compliance, and operational performance while supporting providers and members. The role requires an RN license (WI or compact), 3+ years in utilization management, and 2+ years of leadership experience.