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Utilization Management Nurse
HumanaUtilization Management Nurse coordinating medical services and benefit determinations for Humana’s healthcare operations. Applying RN clinical expertise to support optimal member care remotely in Ohio.
Posted 8/20/2026full-timeRemote • Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $71,100 - $97,800 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical criteria interpretation and utilization management, with a strong focus on member care coordination and communication. Holds a Registered Nurse license in Ohio and possesses extensive experience in acute care settings, ensuring compliance with HIPAA regulations.
Highest-signal resume keywords
Licensed Registered Nurse (RN)Utilization Management ExperienceMedical Surgery Nursing ExperienceCritical Care Nursing ExperienceBilingual
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 InterpretationIndependent Critical ThinkingCare CoordinationTreatment DeterminationAcute Care ExperienceSkilled Nursing ExperienceRehabilitation Nursing ExperiencePharmacy Practice ExperienceMedicare ExperienceMedicaid Experience
Soft Skills
CommunicationDecision-MakingPassion for Consumer Experience
Certifications & Qualifications
Bachelor's DegreeRegistered Nurse License in Ohio
Industry Keywords
Health PlanPHI/HIPAA ComplianceCall Center ExperienceTriage ExperienceTB Screening
About the role
Key responsibilities & impact- Support coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, or services
- Apply clinical knowledge and independent critical thinking to support optimal member care
- Coordinate and communicate with providers, members, and other parties
- Make independent decisions regarding work methods while following established guidelines and procedures
- Travel occasionally to Humana offices for training or meetings
Requirements
What you’ll need- Bachelor's degree
- Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary action
- At least 3 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
- Previous experience in utilization management
- Prior clinical experience, preferably in an acute care, skilled or rehabilitation clinical setting
- Passion for contributing to an organization focused on continuously improving consumer experiences
- Preferred: 3 or more years of experience in a high-volume community or mail-order pharmacy practice environment
- Preferred: Health Plan experience
- Preferred: Previous Medicare/Medicaid experience
- Preferred: Call center or triage experience
- Preferred: Bilingual
- Must complete TB screening if selected
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan
- 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
- Dedicated home workspace arrangement
- Remote work arrangement
- Internet service requirements/support for home employees