Humana provided pay range
This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$71,100.00/yr – $97,800.00/yr
About the Role
Become a part of our caring community and help us put health first.
The RN, Utilization Management (UM) Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of long‑term services and supports (LTSS) and/or benefit administration determinations. The UM Nurse’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The UM Nurse 2 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in‑depth evaluation of variable factors.
Key Responsibilities
Interpret criteria, policies, and procedures to Long Term Services and Support authorizations to provide the best and most appropriate treatment, care, or services for members.
Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
Understand department and organizational strategy and operating objectives, including their linkages to related areas.
Follow established guidelines/procedures.
Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
Required Qualifications
Must reside in the state of Michigan or within a 40‑minute commute to Detroit; if residing in Ohio, Illinois, or Indiana, must be within a 40‑minute commute.
Active, unrestricted Registered Nurse (RN) license in Michigan.
One (1) year of previous experience in utilization management/LTSS service authorization.
Two (2) years of prior clinical experience, preferably in acute care, skilled or rehabilitation clinical setting, or Medicaid Managed Care Organization.
Must be able to work Eastern Standard Time, Monday – Friday 8:00 am – 5:00 pm EST.
Comprehensive knowledge of Microsoft Word, Outlook and Excel.
Ability to work independently under general instructions and with a team.
Preferred Qualifications
Bachelor’s or associate degree in nursing or related field.
Previous Medicare/Medicaid experience.
Previous experience in discharge planning and/or home health or rehabilitation.
Bilingual preferred Spanish, Arabic, Chaldean Neo‑Aramaic or other.
Additional Information
Workstyle: Remote position.
Travel: Occasional travel may be required to attend onsite team engagement meetings at Humana’s Detroit, Michigan office.
Workdays and Hours: Monday – Friday; 8:00 am – 5:00 pm Eastern Standard Time (EST).
Internet Requirement
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only with leadership approval.
Humana will provide home or hybrid home/office employees with telephone equipment appropriate to meet the business requirements for their position.
Must work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.
Compensation and Benefits
The base pay range is $71,100 – $97,800 per year. This job is also eligible for a bonus incentive plan based on company and/or individual performance.
Humana offers competitive benefits including medical, dental and vision coverage, 401(k) retirement savings plan, time off, short‑term and long‑term disability, life insurance and more.
Equal Opportunity Employer
Humana is an equal opportunity employer and prohibits discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.