Experienced Utilization Management Registered Nurse – Remote Opportunity for Clinical Excellence and Patient Care Coordination

Introduction to Humana and Our Mission At Humana, we are dedicated to putting health first for our teammates, customers, and the company as a whole. Through our comprehensive insurance services and CenterWell healthcare services, we strive to make it easier for millions of people to achieve their best health. Our efforts are focused on delivering high-quality care and service when it's needed most, leading to a better quality of life for individuals with Medicare, Medicaid, families, and communities at large. As a Utilization Management Registered Nurse, you will play a vital role in our mission by utilizing your clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. Role Overview The Utilization Management Registered Nurse 2 position is a remote opportunity that requires a licensed, unrestricted Registered Nurse (RN) with a strong background in medical-surgical, heart, lung, critical care, skilled, or rehabilitation nursing. As a Utilization Management Nurse, you will work independently and as part of a team to facilitate optimal care, treatment, and discharge planning for our members. Your responsibilities will include about 50% telephonic outreach, coordinating and communicating with providers, members, or other parties, and interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services. Key Responsibilities: Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. Coordinate and communicate with providers, members, or other parties to facilitate optimal care, treatment, and discharge planning. Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members. Work independently and as part of a team to achieve department, segment, and organizational strategy and operating objectives. Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed. Follow established guidelines and procedures to ensure high-quality care and service. Essential Qualifications To be successful in this role, you will need to possess the following essential qualifications: Licensed, unrestricted Registered Nurse (RN) in the state of Florida or a compact state license with no disciplinary action. Minimum 3 years of medical-surgical, heart, lung, critical care, skilled, or rehabilitation nursing experience. Previous experience in utilization management. Intermediate or better working knowledge of Microsoft Word, Outlook, and Excel. Ability to work independently under general instructions and with a team. Screening Requirements: Level II; AHCA background Associate working in the State of Florida will need Completion of a Level II; AHCA background clearance Fingerprinting. Preferred Qualifications While not required, the following preferred qualifications will make you a more competitive candidate: BSN or Bachelor's degree in a related field. Health Plan experience. Previous Medicare/Medicaid Experience. Bilingual skills. Skills and Competencies To excel in this role, you will need to possess the following skills and competencies: Clinical knowledge and critical thinking skills to interpret criteria, policies, and procedures. Excellent communication and interpersonal skills to coordinate and communicate with providers, members, or other parties. Ability to work independently and as part of a team to achieve department, segment, and organizational strategy and operating objectives. Strong problem-solving skills to make decisions regarding own work methods, occasionally in ambiguous situations. Ability to follow established guidelines and procedures to ensure high-quality care and service. Career Growth Opportunities and Learning Benefits At Humana, we are committed to the growth and development of our associates. As a Utilization Management Registered Nurse, you will have access to a range of career growth opportunities and learning benefits, including: Professional development programs to enhance your clinical knowledge and critical thinking skills. Opportunities for advancement within the company. Access to a range of training and education programs to support your career goals. A supportive and collaborative work environment that encourages innovation and creativity. Work Environment and Company Culture At Humana, we pride ourselves on our positive and inclusive company culture. As a remote associate, you will be part of a dynamic and supportive team that values work-life balance and flexibility. Our company culture is built on the following principles: A commitment to putting health first for our teammates, customers, and the company as a whole. A focus on delivering high-quality care and service to our members. A supportive and collaborative work environment that encourages innovation and creativity. A range of benefits and perks to support your physical, emotional, and financial well-being. Compensation, Perks, and Benefits As a Utilization Management Registered Nurse at Humana, you will be eligible for a range of compensation, perks, and benefits, including: A competitive salary range of $69,800 - $96,200 per year. A bonus incentive plan based on company and individual performance. A range of benefits, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and short-term and long-term disability. Access to a range of training and education programs to support your career goals. A supportive and collaborative work environment that encourages innovation and creativity. Conclusion If you are a licensed, unrestricted Registered Nurse with a strong background in medical-surgical, heart, lung, critical care, skilled, or rehabilitation nursing, and a passion for delivering high-quality care and service, we encourage you to apply for this exciting opportunity. As a Utilization Management Registered Nurse at Humana, you will be part of a dynamic and supportive team that values work-life balance and flexibility. Don't miss out on this chance to take your career to the next level and make a real difference in the lives of our members. Apply now and let's discuss how you can become a vital part of our success story. Apply for this job