About Humana


Job Category:

Member Quality & Financials - Utilization Management


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Telephonic UM RN - Louisville or Dublin

Humana - Work At Home, Ohio

Posted: 10/14/2018


The Utilization Management RN utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management RN work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


The Utilization Management RN uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.


Required Qualifications

  • Associates degree
  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action.
  • 3-5 years of Nursing experience required
  • Previous experience in utilization management required
  • Comprehensive knowledge of Microsoft Word, Outlook and Excel
  • 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 of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

  • Education: BSN or Bachelor's degree in a related field
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus

Additional Information

This is an office based role in either Louisville, KY or Dublin, OH. 

Scheduled Weekly Hours


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