Utilization Management Nurse - Solutions - Compact RN

Be among the first 25 applicants.

This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

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

Become a part of our caring community and help us put health first. 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 Utilization Management Nurse 2 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 have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value‑based care for members who desire to heal  this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

• 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 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.

Use Your Skills To Make An Impact

Shift is 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 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.
• 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 25mbs download x 10mbs upload is required.
• Check your internet speed at
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

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. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Benefits include medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities.

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.

This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.