The Utilization Management Nurse 2 uses knowledge, communication, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. They coordinate and communicate with providers, members, or other parties to facilitate optimal care.
Success in this role requires the following:
Understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Ability to self-direct, take initiative and meet deadlines.
Ability to work Independently and collaboratively.
Desire to embrace continuous learning in an agile work environment.
Strong attention to detail to ensure requirements are met and guidelines followed.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Required Qualifications
Associate’s Degree or higher
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
Compact (multistate) RN license
3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team
Preferred Qualifications
BSN
Knowledge of Utilization Management
Previous Medicare and Medicaid Experience
Previous claims experience
Previous provider dispute experience
Additional Information
Work hours will be an 8.5-hour shift between 7:00am - 5:00pm CST.
Work-At-Home Requirements
To ensure WAH employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide WAH or hybrid employees with telephone equipment appropriate to meet the business requirements for their position/job.
Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Scheduled Weekly Hours
40Pay Range
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 on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.Application Deadline: 11-14-2025
Equal Opportunity Employer
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.