Remote Utilization Management RN

Humana Inc; Cheyenne (WY); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is hiring a Utilization Management Registered Nurse for remote work. You will apply clinical nursing expertise to interpret, coordinate, document, and communicate medical services and benefit determinations for post-acute care settings.

You will make criteria-based decisions, liaise with providers and members, and support coordinated care while aligning with department goals. Remote, nationwide travel may be required occasionally.

Qualifications

• Must hold Compact Registered Nurse (RN) license.
• Minimum of 1+ year clinical RN experience in hospital, SNF, Home Health, or acute care.
• Preferred: utilization management/UR experience in health plan or acute care settings.
• Knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Experience in fully remote, metrics‑focused roles.
• Experience as MDS Coordinator or discharge planner in acute care.
• Experience as RN for Medicare Certified Home Health agency.
• Health Plan or Medicare/Medicaid experience.
• Call center or triage experience.
• BSN or bachelor’s degree in a related field.

Responsibilities

• Use clinical nursing skills to interpret, coordinate, document, and communicate medical services and benefit determinations.
• Make determinations based on established medical criteria from attending providers.
• Complete request determinations within established processing time frames.
• Communicate with providers, members, and other parties to facilitate care and treatment.
• Help deliver coordinated care for members.
• Understand department, segment, and organizational strategy and operating goals.

Skills

Clinical nursing skills

Communication with providers

Patient care coordination

Remote work experience

Education

RN license (Compact)

BSN or related bachelor’s degree

Job description

Humana Inc. is hiring a Utilization Management Registered Nurse for remote work. You will apply clinical nursing expertise to interpret, coordinate, document, and communicate medical services and benefit determinations for post-acute care settings.

You will make criteria-based decisions, liaise with providers and members, and support coordinated care while aligning with department goals. Remote, nationwide travel may be required occasionally.