<h3><b>Become a part of our caring community</b><br></h3><p>The Utilization Management Nurse uses clinical knowledge towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. You will coordinate and communicates with providers, members, or other parties to facilitate optimal care and treatment.</p><h3><br><b>Use your skills to make an impact </b><br></h3><h3>Required Qualifications</h3><ul><li>Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non compact licensure</li><li>3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings)</li><li>Work rotation to include weekends and possible holiday coverage required</li><li>Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting</li><li>Comprehensive knowledge of Microsoft Word, Outlook and Excel)</li></ul><h3>Preferred Qualifications</h3><ul><li>Previous experience in utilization management</li><li>Education: BSN or bachelor's degree in a related field</li><li>Health Plan experience</li><li>Previous Medicare/Medicaid experience</li><li>Bilingual in English and Spanish</li></ul><h3>Additional Information</h3><p>To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:</p><div><p>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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.</p></div>Work at Home RequirementsTo ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.<h3>Scheduled Weekly Hours</h3>40<h3>Pay Range</h3>The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job relat