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Utilization Management Nurse: Home Solutions



Posted on Wednesday, July 26, 2023


Full-Time, Remote Telephonic opportunity

As a Utilization Management RN working on the Home Solutions team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time
Rotational Evening, Weekends and Holiday coverage required (between 8 AM to 8 PM EST)


-- A secure home-office space, full-time uninterrupted work hours and hard-wired, high-speed internet service is required for this position --

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

  • Excellent organizational and time management skills

  • Solid analytical skills to understand and interpret data to make recommendations to improve patient care.

  • Technical savvy and ability to navigate multiple systems and screens while working cases.

  • Collaboration skills to effectively interact with multiple parties both internal and external.

  • An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

  • Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.

  • Ability to follow established guidelines/procedures.


Required Qualifications

  • Minimum of associate degree in nursing

  • Licensed Registered Nurse (RN) in a compact state with no disciplinary action.

  • Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.

  • Three (3) or more years of progressive clinical experience

  • Effective telephonic and virtual communication skills

  • Comprehensive knowledge of Microsoft Word, Outlook and Excel

  • Ability to work independently under general instructions and within a team.

Work-At-Home Requirements

  • 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 is 25mbs download x 10mbs upload is required.

  • Check your internet speed at

  • A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

Preferred Qualifications

  • BSN

  • 2 to 3 years of home health experience and/or utilization management experience

  • Experience in a managed care setting

  • Health Plan experience

  • CGX experience

  • Bilingual in English/Spanish

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire SMS Text Messaging to enhance our hiring and decision-making ability. Modern Hire Text Messaging allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

ALERT: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website. #LI-Remote

Scheduled Weekly Hours


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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 - $96,200 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.