Experienced Utilization Management Review Nurse – Remote Opportunity for Clinical Nursing Professionals to Drive Health First Initiatives

Introduction to Humana and Our Mission

At Humana, we are dedicated to putting health first for our members, patients, and associates. As a leader in the healthcare industry, we strive to make a positive impact on the lives of millions of people across the United States and Puerto Rico. Our commitment to delivering high-quality, patient-centered care is unwavering, and we are seeking talented and compassionate professionals like you to join our team. As a Utilization Management Review Nurse, you will play a vital role in supporting the coordination, documentation, and communication of medical services and benefit administration determinations.

Job Highlights and Responsibilities

As a Utilization Management Review Nurse at Humana, you will be part of a caring community that values collaboration, innovation, and excellence. Your key responsibilities will include:

• Utilizing clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures and provide the best and most appropriate treatment, care, or services for members
• Coordinating and communicating with providers, members, or other parties to facilitate optimal care and treatment
• Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Making decisions regarding own work methods, occasionally in ambiguous situations, and requiring minimal direction and receiving guidance where needed
• Following established guidelines and procedures to ensure compliance and quality

Essential Qualifications and Skills

To be successful in this role, you will need:

• A current license as a Registered Nurse (RN) with no disciplinary action
• 3-5 years of experience in Medical Surgery, Heart, Lung, or Critical Care Nursing
• Previous experience in utilization management, preferably in an acute care, skilled, or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel
• Ability to work independently under general instructions and as part of a team
• A passion for contributing to an organization focused on continuously improving consumer experiences
• Availability to work Monday-Friday from 10am-6:30pm EST

Preferred Qualifications and Skills

While not required, the following qualifications and skills are preferred:

• Bachelor's degree in Nursing or a related field
• Health plan experience, particularly with Medicare and Medicaid
• Call center or triage experience
• Bilingual skills

Career Growth Opportunities and Learning Benefits

At Humana, we are committed to supporting the growth and development of our associates. As a Utilization Management Review Nurse, you will have access to:

• Ongoing training and education to enhance your clinical skills and knowledge
• Opportunities for professional advancement and career progression
• A collaborative and supportive work environment that fosters innovation and excellence
• A comprehensive benefits package that includes medical, dental, and vision coverage, 401(k) retirement savings plan, and paid time off

Work Environment and Company Culture

At Humana, we value diversity, equity, and inclusion and are committed to creating a work environment that is welcoming and inclusive for all associates. Our company culture is built on a foundation of:

• Respect and empathy for our members, patients, and associates
• A commitment to delivering high-quality, patient-centered care
• A collaborative and supportive work environment that fosters innovation and excellence
• A focus on whole-person well-being and work-life balance

Compensation, Perks, and Benefits

We offer a competitive salary range of $69,800 - $96,200 per year, depending on experience and location. Additionally, you will be eligible for a bonus incentive plan and a comprehensive benefits package that includes:

• Medical, dental, and vision coverage
• 401(k) retirement savings plan
• Paid time off, including vacation, sick leave, and holidays
• Short-term and long-term disability coverage
• Life insurance
• Opportunities for professional advancement and career progression

Conclusion and Call to Action

If you are a compassionate and skilled Utilization Management Review Nurse looking for a new challenge, we encourage you to apply for this exciting opportunity. At Humana, we are committed to putting health first and making a positive impact on the lives of millions of people. Join our team and be part of a caring community that values collaboration, innovation, and excellence. Apply today and take the first step towards a rewarding and challenging career with Humana!

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