Utilization Management Nurse

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 coordination, documentation, and communication of medical services and benefit administration determinations • Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, or services • Apply clinical knowledge and independent critical thinking to support optimal member care • Coordinate and communicate with providers, members, and other parties • Make independent decisions regarding work methods while following established guidelines and procedures • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• Bachelor's degree • Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary action • At least 3 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience • Previous experience in utilization management • Prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting • Passion for contributing to an organization focused on continuously improving consumer experiences • Preferred: 3 or more years of experience in a high-volume community or mail-order pharmacy practice environment • Preferred: Health Plan experience • Preferred: Previous Medicare/Medicaid experience • Preferred: Call center or triage experience • Preferred: Bilingual • Must complete TB screening if selected • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan • 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 • Dedicated home workspace arrangement • Remote work arrangement • Internet service requirements/support for home employees