Utilization Management Nurse

Humana Inc; Ohio; Remote; USD 71,000 - 98,000; Full time

Job summary

Join Humana Inc. as a SNF Utilization Management Nurse, where you'll leverage your clinical expertise to enhance member care. As a critical team member, you will coordinate with providers and ensure compliance with clinical guidelines, all while working towards better health outcomes. Enjoy a thorough benefits package and a supportive work environment focused on health improvement.

Benefits

Comprehensive medical, dental, and vision plans

401(k) with company match

Paid time off and disability benefits

Life insurance

Performance-based bonuses

Qualifications

• Compact licensure and RN license required.
• 2-3 years of skilled nursing facility experience or management review experience.
• Ability to work independently and as part of a team.

Responsibilities

• Coordinate and communicate with providers and members for optimal care.
• Interpret criteria, policies, and procedures for treatment delivery.
• Make decisions regarding work methods with minimal guidance.

Skills

Communication

Critical thinking

Teamwork

Education

Registered Nurse (RN) License

Bachelor's degree in Nursing (BSN)

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

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

The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to interpret criteria, policies, and procedures, ensuring the delivery of the most appropriate treatment, care, or services for members. This role involves coordinating and communicating with providers, members, and other parties to facilitate optimal care and treatment. The nurse understands the department, segment, and organizational strategy and operating objectives, including their linkages to related areas. The position requires making decisions regarding work methods, often in ambiguous situations, with minimal guidance, following established guidelines and procedures.

Use your skills to make an impact

Required Qualifications

• Compact licensure
• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action
• 2-3 years of skilled nursing facility experience and/or skilled nursing facility utilization management review experience
• Prior clinical experience, preferably in an acute care, skilled, or rehabilitation clinical setting
• Proficiency in Microsoft Word, Outlook, and Excel
• Ability to work independently under general instructions and as part of a team
• Reliable high-speed internet connection (minimum 10x1 Mbps) for home office; satellite and wireless internet are not permitted
• A passion for contributing to an organization focused on improving consumer experiences

Preferred Qualifications

• Bachelor's degree in Nursing (BSN) or related field
• Experience with health plans
• Previous Medicare/Medicaid experience is a plus
• Bilingual abilities are a plus

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: $71,100 - $97,800 per year. Compensation may vary based on location, skills, and experience. This position is eligible for a performance-based bonus.

Description of Benefits: Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more, supporting your overall well-being.

Application Deadline: 06-08-2025

About us

Humana Inc. is committed to putting health first for our teammates, customers, and community. We strive to make it easier for people to achieve their best health through our insurance and healthcare services, enhancing quality of life for diverse populations.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We are committed to affirmative action and employment decisions based solely on valid job requirements.