RN, Manager, Utilization Management Nursing

Humana Inc; Phoenix (AZ); Remote; USD 94,000 - 131,000; Full time

Job summary

A leading healthcare organization is seeking a Manager of Utilization Management Nursing to oversee operations and ensure compliance with healthcare guidelines. This remote position requires an active Michigan RN license and a minimum of two years in management. Candidates will lead a team, analyze data for operational metrics, and facilitate collaboration among departments. Competitive compensation of $94,900 - $130,500 annually with comprehensive benefits offered.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Life insurance

Qualifications

• An active, unrestricted Registered Nurse (RN) license in the state of Michigan.
• Previous experience in utilization management and/or utilization review.
• Minimum of two (2) years of proven experience in management or leadership role.
• Prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.

Responsibilities

• Provide leadership and oversight of UM staff in daily operations.
• Interpret criteria, policies, and procedures for optimal member treatment.
• Hire, train, coach, counsel and evaluate performance of direct reports.
• Implement processes compliant with MDHHS and NCQA guidelines.
• Collaborate with UM leadership to improve clinical outcomes.

Skills

Leadership

Clinical knowledge

Communication skills

Critical thinking

Education

Bachelor's degree in health services or related field

Job description

Overview

Become a part of our caring community and help us put health first

The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

• Responsible for providing leadership and oversight of the physical health utilization management (UM) staff in daily operations.

• Uses clinical knowledge, communication skills, and independent critical thinking skills toward interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.

• Hire, train, coach, counsel and evaluate performance of direct reports.

• Implements and maintain processes that are compliant with the Michigan Department of Health and Human Services (MDHHS) and National Committee for Quality Assurance (NCQA) guidelines.

• Works collaboratively with UM leadership to assess and mitigate inefficiencies and provide solutions to improve clinical outcomes.

• Collect and analyze data as necessary to drive operational metrics and associate performance.

• Coordinate and communicate with Providers, Members, or other parties to facilitate optimal care and treatment.

• Makes decisions that are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

• Facilitate cross-departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across functional areas.

Qualifications

• An active, unrestricted Registered Nurse (RN) license in the state of Michigan.

• Previous experience in utilization management and/or utilization review.

• Minimum of two (2) years of proven experience in management or leadership role.

• Prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.

• Ability to work independently under general instructions and with a team.

Preferred Qualifications

• BSN, bachelor’s degree in health services, healthcare administration, or business administration.

Additional Information

• Workstyle: This is a remote position.

• Travel: Up to 25% travel may be required to attend onsite team engagement meetings at Humana’s Detroit, Michigan office, as well as conferences and events both within and outside the state of Michigan.

• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)

• Direct Reports: Up to 15 associates.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 12-26-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.