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Manager, Utilization Management – Nursing
HumanaHumana utilization management nursing manager coordinating clinical care and benefit determinations remotely. Leading departmental projects, provider communication, and member care decisions.
Posted 8/4/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $94,900 - $130,500 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in utilization management nursing operations, clinical criteria interpretation, and effective communication with providers and members. Holds an active Registered Nurse license in Virginia or eNLC, with a strong background in project leadership and clinical experience in acute care settings.
Highest-signal resume keywords
Active Licensed Registered Nurse (RN)Utilization Management ExperienceProject Lead ExperienceIntermediate to Advanced Microsoft Office SkillsBilingual
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Criteria InterpretationUtilization ManagementDischarge PlanningCase ManagementTroubleshooting Technical DifficultiesProject CoordinationDocumentationCommunicationProblem SolvingTeam Leadership
Soft Skills
CollaborationIndependent WorkInterpersonal CommunicationCoachingPerformance Evaluation
Tools & Technologies
Microsoft Office WordMicrosoft Office ExcelMicrosoft Office PowerPointRemote Communication Platforms
Certifications & Qualifications
Active Registered Nurse License in VirginiaEnhanced Compact License (eNLC)
Industry Keywords
Health Plan ExperienceMedicare ExperienceMedicaid ExperienceAcute CareSkilled CareRehabilitation SettingPHI/HIPAA ComplianceCall Center ExperienceTriage Experience
About the role
Key responsibilities & impact- Support the coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, or services for members
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Determine approaches, resources, schedules, and goals for departmental projects and initiatives
- Solve moderately complex problems using advanced technical knowledge
- Collaborate across departments
- Conduct briefings and area meetings
- Maintain frequent contact with managers across the department
- Lead and support utilization management nursing operations
Requirements
What you’ll need- Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license (eNLC) with no disciplinary action
- Minimum 2 years of team lead and/or project lead experience
- Minimum 2 years of progressive clinical experience, preferably in an acute care, skilled, or rehabilitation setting
- Intermediate to Advanced knowledge of Microsoft Office Word, Excel, and PowerPoint
- Ability to navigate multiple systems and platforms
- Ability to troubleshoot and resolve basic technical difficulties in a remote environment
- Ability to work independently under general instructions and with a team
- Residence in a state participating in the enhanced compact license (eNLC)
- Ability to work a minimum of 8 hours between 8:00 AM and 5:00 PM Eastern Time
- Ability to work rotating holidays or weekends as determined by business needs
- Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
- Preferred: Bachelor's Degree
- Preferred: Prior supervisory experience, including interviewing, hiring, training, performance evaluation, coaching, and termination
- Preferred: Utilization management experience
- Preferred: Discharge planning or case management experience
- Preferred: Health Plan experience
- Preferred: Medicare/Medicaid experience
- Preferred: Call center or triage experience
- Bilingual is a plus
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- 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
- Self-provided home internet service
- Remote work at home
- Occasional travel to Humana offices for training or meetings