Manager, Utilization Management Team (RN)

Humana Inc   •  


Industry: Healthcare


5 - 7 years

Posted 152 days ago

This job is no longer available.


The Manager, Utilization Management utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form ofobjectives and determines approach, resources, schedules and goals.


Role: Manager, Utilization Management Team (RN)

Assignment: Medicare

Location: Work at home, Mountain or Pacific Time only

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be part of a clinical leadership team, where we provide innovative health solutions to members and providers.

Humana is seeking a Manager for the Utilization Management Team who will lead and guide our Utilization Management teams in providing integrated services for our Medicare members. Along with leading these teams this individual will provide ongoing associate coaching and feedback to enhance associate contributions, competency, and performance.

Ideal Skillset

The ideal candidate for this role will have a proven track record managing a team of nurses; excellent communication skills both verbal and written; at least 5 years of varied clinical experience; a background working in utilization management; and live in either the Mountain or Pacific Time zones.

As a Manager you will:

  • Oversee day to day operations and human capital for a defined operational area.
  • Achieve performance metrics for a fast paced clinical environment.
  • Assure compliance with mandated and corporate policies regarding other departmental areas such as medical management, and utilization management.
  • Develop team members and creating department process flows.

Role Essentials

  • Nursing License; RN
  • Live in either the Mountain or Pacific Time zones
  • Bachelor’s Degree in Nursing, Business, Finance, a related field or work equivalent experience with familiarity handling Medicare guidelines
  • Progressive experience in the health solutions industry, with emphasis on leading and managing teams
  • Proficiency in analyzing and interpreting financial and clinical trends
  • At least 5 years of varied clinical experience
  • Comprehensive knowledge of all Microsoft Office applications, including Word and Excel
  • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems if 10Mx1M
  • Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.

Role Desirables

  • Master’s Degree in Business Administration or a related field
  • Experience in utilization management and/or case management
  • Health plan experience

Reporting Relationships

You will have multiple direct reports, and will report to an Associate Director.

Scheduled Weekly Hours