RN Utilization Management Nurse 2

Humana; Orlando (FL); Remote; USD 71,000 - 98,000; Full time

Job summary

An established industry player is seeking a Utilization Management Nurse 2 to join their caring community. In this role, you will utilize your clinical nursing skills to support the coordination and communication of medical services. You will apply critical thinking and clinical knowledge to ensure members receive the most appropriate treatment. This position offers a chance to work independently while being part of a collaborative team, helping to put health first for diverse populations. If you are passionate about healthcare and want to make a difference, this opportunity is perfect for you.

Benefits

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Paid time off

Life insurance

Disability insurance

Qualifications

• Active Florida license or Compact Registered Nurse license without restrictions.
• At least 2 years of clinical experience in acute care or rehabilitation settings.

Responsibilities

• Coordinates and communicates with providers and members for optimal care.
• Makes decisions regarding work methods with minimal guidance.

Skills

Clinical nursing skills

Communication skills

Critical thinking

Computer skills

Ability to work independently

Education

Active Florida RN license

2 years of clinical experience

3 years in Utilization Management

Job description

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This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$71,100.00/yr - $97,800.00/yr

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

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The work assignments are varied and often require interpretation and independent decision-making.

The Utilization Management Nurse 2 applies clinical knowledge, communication skills, and critical thinking to interpret criteria, policies, and procedures to provide the most appropriate treatment, care, or services for members.

Responsibilities

• Coordinates and communicates with providers, members, and other parties to facilitate optimal care and treatment.
• Understanding of department, segment, and organizational strategies and their linkages.
• Decisions regarding work methods, sometimes in ambiguous situations, with minimal guidance.
• Follows established guidelines and procedures.
• This is a weekday position, Monday to Friday, 8:30 am - 5:00 pm EST.

Qualifications

• Active Florida license or Compact Registered Nurse license without restrictions.
• At least 2 years of clinical experience in acute care, skilled, or rehabilitation settings.
• Minimum of 3 years experience in Utilization Management with Medicare and/or Medicaid guidelines.
• Excellent computer and communication skills.
• Ability to work independently and as part of a team.

Preferred Qualifications

• Experience in health plans.
• MCG Certification.
• Bilingual skills are a plus.

Additional Information

This is a weekday position, Monday to Friday, 8:30 am - 5:00 pm EST.

Work-At-Home Requirements

• Internet speed of at least 25 Mbps download and 10 Mbps upload; wired connection recommended.
• Satellite, cellular, or microwave connections require leadership approval.
• Employees in California, Illinois, Montana, or South Dakota will receive internet expense reimbursement bi-weekly.
• Humana provides necessary telephone equipment.
• Work from a dedicated, interruption-free space to protect member information.

Hiring Process

We may contact candidates via text and email using Modern Hire for interviews, which may include pre-recorded video, voice, or text interactions.

For questions, contact the Ask A Recruiter team via go/Buzz with the requisition number.

Occasional travel to Humana offices may be required for training or meetings.

Work Schedule and Compensation

40 hours/week. Salary range: $71,100 - $97,800 annually, based on location and experience. Eligible for performance bonuses.

Benefits

Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

About Humana

Humana is dedicated to putting health first, making healthcare accessible and effective for diverse populations.

Equal Opportunity

Humana is committed to equal employment opportunity and affirmative action, welcoming applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.