Utilization Management Nurse 2

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

Job summary

Join a forward-thinking organization dedicated to health and well-being. As a Utilization Management Nurse 2, you will leverage your clinical expertise and critical thinking to ensure optimal care for members. This role emphasizes independent decision-making and collaboration with healthcare providers to facilitate efficient service delivery. With a focus on improving consumer experiences, you will play a vital role in a supportive environment that values your contributions. If you are passionate about making a difference in healthcare, this opportunity is perfect for you.

Qualifications

• Licensed RN in Florida or with compact licensure, no disciplinary actions.
• Previous clinical experience, preferably in acute care.

Responsibilities

• Utilize clinical nursing skills for medical services coordination.
• Make independent decisions in ambiguous situations.

Skills

Clinical Nursing Skills

Communication Skills

Critical Thinking

Microsoft Word

Microsoft Outlook

Microsoft Excel

Team Collaboration

Education

Licensed Registered Nurse (RN)

BSN or related bachelor's degree

Tools

Microsoft Office Suite

Job description

Job Profile

Utilization Management Nurse 2

Job Level

Professional 2

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, ensuring the delivery of appropriate treatment, care, or services. They coordinate and communicate with providers, members, and other parties to facilitate optimal care. The role requires understanding of departmental, segment, and organizational strategies, and involves making decisions independently, occasionally in ambiguous situations, following established guidelines and procedures.

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) in Florida or with compact licensure, with no disciplinary actions.
• Previous clinical experience, preferably in acute care.
• Proficiency in Microsoft Word, Outlook, and Excel.
• Ability to work independently and as part of a team.
• Passion for contributing to an organization focused on improving consumer experiences.

Preferred Qualifications

• BSN or related bachelor's degree.
• Experience in utilization management is strongly preferred.
• Knowledge of MCG (Milliman) Criteria.
• Experience with health plans, Medicare, or Medicaid.

Additional Information

• Bilingual skills are a plus.
• Puerto Rico RN License is 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

The estimated annual salary range is $71,100 - $97,800, based on location, experience, and qualifications. The position is eligible for a bonus incentive plan based on performance.

Referral Bonus Information

This position is not eligible for a referral bonus.

About us

Humana Inc. (NYSE: HUM) is dedicated to putting health first—serving our teammates, customers, and communities. We provide insurance and healthcare services that help people achieve their best health, improving quality of life for diverse populations including Medicare, Medicaid, families, and military personnel.

Equal Opportunity Employer

Humana is committed to non-discrimination and affirmative action in employment, ensuring equal opportunity regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Employment decisions are based solely on job requirements and qualifications.