Remote Utilization Management Nurse | Care & Coordination

Santa Barbara Cottage Hospital; United States; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical Benefits

Dental Benefits

Vision Benefits

401(k) Plan

Paid Time Off

Disability Insurance

Life Insurance

Job summary

Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. This remote role may require occasional travel to Humana's offices for training or meetings.

The position emphasizes independent critical thinking, interpretation of criteria, and collaboration with providers to ensure optimal member care and outcomes. 40 hours per week with a competitive pay range and bonus eligibility.

Qualifications

• Licensed RN in Ohio with no disciplinary action.
• At least 3 years in Medical-Surgical, Cardiac or Critical Care.
• Experience in utilization management.
• Clinical experience in acute care, skilled, or rehab setting.
• Passion for improving consumer experiences.

Responsibilities

• Interpret criteria, policies and procedures to determine appropriate care.
• Coordinate and communicate with providers and members to facilitate care.
• Make independent decisions with minimal direction.
• Follow established guidelines and procedures.

Skills

RN licensure

Clinical nursing

Utilization management

Independent decision making

Patient advocacy

Education

Bachelor's Degree

Job description

Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical services and benefit determinations. This remote role may require occasional travel to Humana's offices for training or meetings.

The position emphasizes independent critical thinking, interpretation of criteria, and collaboration with providers to ensure optimal member care and outcomes. 40 hours per week with a competitive pay range and bonus eligibility.