Utilization Management Nurse - Solutions - Compact RN

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

Full‑Time, Remote Telephonic opportunity.

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. As a Utilization Management RN working on the One Home/Home Solutions UM Team, you will use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value‑based care for members who desire to heal at home.

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Excellent organizational and time management skills.
• Solid analytical skills to understand and interpret clinical hermetic information to make recommendations to improve patient outcomes.
• Technical savvy and ability to navigate multiple systems and screens while working cases.
• Collaboration skills to effectively interact with multiple parties both internal and external.
• An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction, receiving guidance where needed.
• Ability to follow established guidelines, processes, and procedures.

Monday - Friday 8:00am - 5:00pm Eastern Standard Time

• Minimum of Associate Degree in nursing.
• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
• Must have a valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
• Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population.
• Effective telephonic and virtual communication skills.
• Comprehensive knowledge of Microsoft Word, Outlook and Excel.
• DOWNLOADABLE but ability to work independently under general instructions and within a team.

• Bachelor’s degree.
• Two (2) or more years of home health experience and/or utilization management experience.
• Experience in a managed care setting.
• Health Plan experience.
• CGX experience.

• Must have the ability to provide a high‑speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
• A minimum standard speed for optimal performance is 25 mbps download × 10 mbps upload.
• Check your internet speed at
• A dedicated office space with minimal interruptions so you can meet productivity requirements and protect member PHI / HIPAA information.

While this is a remote position, occasional travel to Humana'sMeta offices for training or meetings may be required.

40

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based upon geographic location and individual pay will vary based on demonstrated job‑related skills, knowledge, experience, education, certifications, etc. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits encourage personal wellness and smart healthcare decisions for you and your family while also acknowledging that your life extends outside of work. Among our benefits, we provide medical, dental and vision benefits, a 401(k) retirement savings plan, paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave,_ZONE, short‑term and long‑term disability, life insurance and many other opportunities.

Humana…