Utilization Management Nurse

Humana

Utilization Management Nurse reviewing LTSS and HCBS authorizations for Humana, a U.S. healthcare and insurance company.

Posted 8/19/2026full-timeIllinois • 🇺🇸 United StatesJuniorMid-Level💰 $71,100 - $97,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) authorizations, with a strong focus on compliance with Illinois HFS regulations and effective communication with interdisciplinary teams. Proficient in clinical evaluation and decision-making to facilitate optimal care for Illinois Medicaid members.

Highest-signal resume keywords

Licensed Registered Nurse (RN)Utilization ManagementClinical ExperienceMicrosoft Office SuiteMedicare/Medicaid Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

LTSS AuthorizationHCBS Coverage DeterminationClinical EvaluationEvidence-Based Criteria InterpretationCompliance with Regulatory Requirements

Soft Skills

CommunicationCoordinationInterpersonal Skills

Tools & Technologies

Microsoft WordMicrosoft OutlookMicrosoft Excel

Certifications & Qualifications

Registered Nurse (RN) License in Illinois

Industry Keywords

Illinois HFSMedicaidHome HealthDischarge PlanningRehabilitation

About the role

Key responsibilities & impact

Review and authorize Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS)
Evaluate member needs using clinical expertise and evidence-based criteria
Interpret criteria, policies, and procedures related to LTSS authorizations
Make coverage determinations and decisions related to denials for HCBS-covered services
Coordinate and communicate with providers, members, and interdisciplinary teams
Create timely and accurate authorizations and determinations
Ensure compliance with Illinois HFS, contractual, and regulatory requirements
Facilitate optimal care, treatment, and service delivery
Support Illinois Medicaid members and providers

Requirements

What you’ll need

Licensed Registered Nurse (RN) in Illinois with no disciplinary action
1+ years of experience in utilization management/LTSS service authorization
2+ years of clinical experience
Comprehensive knowledge of Microsoft Word, Outlook, and Excel
Must reside in Illinois
Minimum internet speed of 25 Mbps download and 10 Mbps upload
Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information
Preferred: Bachelor's degree in nursing, Health Services, Healthcare Administration, Business Administration, or a related field
Preferred: Previous Medicare/Medicaid experience
Preferred: Experience in discharge planning and/or home health, HCBS, rehabilitation, or LTSS programs

Benefits

Comp & perks

Bonus incentive plan based upon company and/or individual performance
Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Self-provided internet service for remote work
Remote work arrangement
Dedicated workspace support for protecting member PHI/HIPAA information