Manager, Utilization Management – Nursing

🕒 2 days ago

🇺🇸 United States – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Support the coordination, documentation, and communication of medical services and benefit administration determinations • Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Determine approaches, resources, schedules, and goals for departmental projects and initiatives • Solve moderately complex problems using advanced technical knowledge • Collaborate across departments • Conduct briefings and area meetings • Maintain frequent contact with managers across the department • Lead and support utilization management nursing operations

🎯 Requirements

• Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license (eNLC) with no disciplinary action • Minimum 2 years of team lead and/or project lead experience • Minimum 2 years of progressive clinical experience, preferably in an acute care, skilled, or rehabilitation setting • Intermediate to Advanced knowledge of Microsoft Office Word, Excel, and PowerPoint • Ability to navigate multiple systems and platforms • Ability to troubleshoot and resolve basic technical difficulties in a remote environment • Ability to work independently under general instructions and with a team • Residence in a state participating in the enhanced compact license (eNLC) • Ability to work a minimum of 8 hours between 8:00 AM and 5:00 PM Eastern Time • Ability to work rotating holidays or weekends as determined by business needs • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Preferred: Bachelor's Degree • Preferred: Prior supervisory experience, including interviewing, hiring, training, performance evaluation, coaching, and termination • Preferred: Utilization management experience • Preferred: Discharge planning or case management experience • Preferred: Health Plan experience • Preferred: Medicare/Medicaid experience • Preferred: Call center or triage experience • Bilingual is a plus

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Self-provided home internet service • Remote work at home • Occasional travel to Humana offices for training or meetings