Utilization Management Nurse

IntelliResume; Kentucky; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Paid parental and caregiver leave

Short-term and long-term disability

Life insurance

Job summary

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This role suits experienced nurses who can work independently and make critical patient-care decisions.

This full-time, remote position offers a competitive salary and comprehensive benefits, with duties including interpreting criteria, coordinating with providers and members, and following established guidelines.

Qualifications

• Bachelor’s degree required.
• 3-5 years of Medical-Surgery, Heart, Lung, or Critical Care Nursing experience.
• Licensed Registered Nurse (RN) with a Compact License

Responsibilities

• Interpret criteria, policies, and procedures using clinical knowledge.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care.
• Make independent determinations regarding appropriate courses of action.
• Follow established guidelines and procedures.
• Work independently under general instructions and as part of a team.

Skills

Clinical nursing

Independent decision making

Communication skills

Education

Bachelor's degree

Job description

About This Role

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. This role is ideal for experienced nurses who can work independently and make critical decisions regarding patient care.

Highlights

• Pay: $71,100 - $97,800/year
• Location: Remote, KY
• Schedule: Full-time

What You'll Do

• Utilize clinical knowledge and communication skills to interpret criteria, policies, and procedures.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care.
• Make independent determinations regarding appropriate courses of action.
• Follow established guidelines and procedures.
• Work independent under general instructions and as part of a team.

Requirements

• Education:
  • Bachelor’s degree required
• Experience:
  • 3 - 5 years of Medical Surgery, Heart, Lung, or Critical Care Nursing experience required
  • Prior clinical experience in an acute care, skilled, or rehabilitation clinical setting preferred
• Licenses & Certifications:
  • Licensed Registered Nurse (RN) with a Compact License required

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off, including company and personal holidays
• Paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through their insurance services and healthcare services, they make it easier for millions of people to achieve their best health, delivering the care and service needed when it is needed.