Manager, Utilization Management – Nursing

🔥 8 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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

• Lead and oversee Utilization Management operations supporting Long-Term Services and Supports members • Support coordination, documentation, and communication of medical services and benefit administration determinations • Ensure timely and accurate authorization creation and determinations in accordance with HFS, contractual, and regulatory requirements • Lead and oversee Utilization Management Assistant Supervisors supporting LTSS populations • Monitor Electronic Visit Verification compliance and utilization trends to support quality and program integrity • Monitor productivity, quality, utilization, and turnaround-time metrics • Provide operational oversight for LTSS Utilization Management operations and covered services • Hire, train, coach, counsel, and evaluate direct reports • Assess and mitigate inefficiencies and develop solutions to improve clinical outcomes • Collect and analyze data to drive operational metrics and associate performance • Collaborate with Care Management, Quality, Medical Directors, and operational partners • Make decisions regarding resources, approach, and tactical operations for departmental projects and initiatives • Facilitate cross-departmental collaboration, briefings, and area meetings • Maintain frequent contact with managers across functional areas

🎯 Requirements

• Licensed Registered Nurse in Illinois, with no disciplinary action • Minimum 3 years of Utilization Management experience • Experience preferably in Medicaid Managed Care and/or Long-Term Services and Supports, including leadership of supervisors or team leads • Previous experience in utilization management • Passion for contributing to continual improvement of Member experiences • Ability to work effectively from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Home internet with at least 25 Mbps download and 10 Mbps upload speeds • Preferred: BSN or Bachelor's degree in Health Services, Healthcare Administration, or Business Administration • Preferred: Prior management experience • Preferred: Health Plan experience • Preferred: Prior Medicare/Medicaid experience • Preferred: Bilingual

🏖️ 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 internet service for home employees, with minimum 25 Mbps download and 10 Mbps upload • Remote work arrangement • Occasional travel to Humana offices for training or meetings