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Clinical UM Registered Nurse

Other Jobs To Apply

R-411396

Become a part of our caring community

    As a Utilization Management Nurse 2, you will use clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. You will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Use your skills to make an impact

Required Qualifications
  • Active Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non compact licensure
  • 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
  • Prior clinical experience in acute care, skilled or rehabilitation clinical settings
  • Comprehensive knowledge of Microsoft Word, Outlook and Excel)
  • Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Must be willing to be in weekend rotation and possible holiday coverage.
  Preferred Qualifications
  • 3+ years of experience working in a high-volume and fast paced environment
  • Previous experience in utilization management
  • Education: BSN or bachelor's degree in a related field
  • Health Plan experience
  • Previous Medicare/Medicaid Experience
  • Call center or triage experience
  • Bilingual English and Spanish (read/write/speak)
  Additional Information   To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:   At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.   Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.   Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.   Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.     Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.  Scheduled Weekly Hours   40  Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.  $71,100 - $97,800 per year  This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.  Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.    Application Deadline: 05-06-2026

About us

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.    About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
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