Utilization Management Nurse

IntelliResume; Louisiana (MO); On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid time off

Parental leave

Job summary

Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations. This remote role requires a Louisiana RN license and offers a stable, full-time schedule with standard business hours.

The candidate will interpret guidelines, coordinate with providers and members, and make independent decisions to ensure quality patient care within Medicaid Care Management.

Qualifications

• RN license in Louisiana required.
• 3+ years of varied RN nursing experience.
• Experience in Utilization Management Review or Prior Authorization preferred.
• Medicare/Medicaid experience a plus.

Responsibilities

• Interpret criteria, policies, and procedures using clinical knowledge.
• Coordinate with providers, members, and other parties to facilitate care.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Support the Medicaid Care Management Team.
• Participate in training programs spanning approximately four to six weeks.

Skills

RN nursing experience

Utilization Management

Prior Authorization

Medicare/Medicaid experience

Education

RN License Louisiana

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, LA
• Department/Unit: Care Management
• Schedule: Full-time, Monday through Friday, 8:00 AM to 5:00 PM Central Time
• Residency: Must reside in the state of Louisiana

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 decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Support the Medicaid Care Management Team.
• Participate in training programs spanning approximately four to six weeks.

Requirements

Education:

• RN License in the state of Louisiana required

Experience:

• 3+ years of varied RN nursing experience
• Experience in Utilization Management Review and/or Prior Authorization preferred
• Previous Medicare/Medicaid experience a plus

Licenses & Certifications:

• Current RN License in Louisiana
• Compact Nursing License preferred

Benefits

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

About Humana

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