Humana · 4 months ago
SNF Utilization Management RN - Compact Rqd
United States
Full-time
Remote
Entry, Mid Level
$71K/yr - $98K/yr
1+ years expHumana Inc. is committed to putting health first through its insurance and healthcare services. They are seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to support the coordination, documentation, and communication of medical services, ensuring optimal care and treatment for members.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations
Interprets criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
Follows established guidelines/procedures
Qualification
Required
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
MUST have Compact License
Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Education: BSN or Bachelor's degree in a related field
Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc
Experience as an MDS Coordinator or discharge planner in an acute care setting
Previous experience in utilization management/utilization review for a health plan or acute care setting
Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
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