Utilization Management Manager

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 nurses and support staff responsible for utilization management and prior authorization activities • Oversee medical necessity and level-of-care reviews for inpatient, outpatient, and behavioral health services • Ensure authorization decisions comply with regulatory requirements and internal policies • Monitor productivity, quality, service levels, and operational performance metrics • Guide resolution and escalation of complex clinical and operational issues • Educate providers on utilization management, medical necessity, and prior authorization requirements • Oversee provider outreach activities • Ensure accurate entry, maintenance, and documentation of clinical information in medical management systems • Lead process improvement and trend analysis projects • Support departmental policies, procedures, and workflow standards • Collaborate with cross-functional partners to address operational challenges and improve outcomes • Conduct team meetings, coaching sessions, and performance discussions • Manage departmental resources and workflow • Promote accountability, quality, collaboration, and continuous improvement

🎯 Requirements

• Bachelor's degree • Active, unrestricted Registered Nurse license in Wisconsin or a compact state • 3+ years of utilization management experience • 2+ years of leadership experience managing clinical or operational teams • Experience writing complex macros for Excel • Monday–Friday availability, 8:00am–5:00pm Central Standard Time • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental and caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated home workspace arrangement • Remote work arrangement • Occasional travel to Humana offices for training or meetings