Remote Utilization Management RN

Humana; Wisconsin; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills to coordinate, document and communicate medical services and benefit determinations. This role requires the ability to interpret guidance and make independent decisions in varied cases, with a Monday–Friday 8:00am–5:00pm EST schedule.

The position supports remote work with occasional travel, and requires an RN with a compact license and 3+ years of geriatric clinical experience, plus proficiency in

Qualifications

• Associate degree in nursing is required.
• Current RN license in a compact state with no disciplinary action.
• Must have a valid compact license or be eligible to upgrade to compact licensure.
• Three or more years of progressive clinical experience including direct geriatric patient care.
• Effective telephonic and virtual communication skills.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• Ability to work independently under general instructions and within a team.

Responsibilities

• Coordinate documentation and communication of medical services and benefit determinations.
• Support coordination of care using clinical nursing skills.
• Interpret guidelines to determine appropriate actions in varying situations.
• Collaborate with internal and external stakeholders.

Skills

Clinical nursing skills

Telephonic communication

Microsoft Word

Outlook

Excel

Independent decision making

Collaboration

Education

Associate Degree in Nursing

Tools

Compact state RN license

Job description

Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills to coordinate, document and communicate medical services and benefit determinations. This role requires the ability to interpret guidance and make independent decisions in varied cases, with a Monday–Friday 8:00am–5:00pm EST schedule.

The position supports remote work with occasional travel, and requires an RN with a compact license and 3+ years of geriatric clinical experience, plus proficiency in