Utilization Management Registered Nurse - Compact ...

Join Our Passionate Team and Make a Difference in Healthcare! The Utilization Management Registered Nurse plays a crucial role in applying your clinical expertise to coordinate, document, and communicate decisions about medical services and benefits. This is an excellent opportunity for someone who is ready to utilize their skills in a dynamic environment. In this position, you will leverage your clinical knowledge, strong communication abilities, and critical thinking skills to interpret guidelines, policies, and procedures, ensuring our members receive the highest quality of care. Collaboration with healthcare providers, members, and various stakeholders is key to helping us achieve our organizational goals. You'll need to understand departmental and organizational strategies and make informed decisions with minimal supervision. Make a Significant Impact with Your Expertise! Required Qualifications: Active Registered Nurse (RN) license with no disciplinary actions. Must possess a Compact License. At least one year of clinical experience as an RN in an acute care setting, with preferred experience in specialty areas such as critical care, emergency room, or trauma units. Proficient in Microsoft Word, Outlook, and Excel. Able to work independently under general guidance while also thriving in a teamwork environment. Enthusiastic about contributing to an organization that focuses on enhancing the consumer experience. Preferred Qualifications: Bachelor's degree in Nursing (BSN) or a related field. Three or more years of clinical experience in acute care settings, especially in critical care, emergency, or trauma environments. Experience as an MDS Coordinator or discharge planner within an acute care context. Prior involvement in utilization management or review within a health plan or acute care setting. Possession of a Compact License along with a single-state RN license in non-compact states such as California, Hawaii, Nevada, or Oregon. Health plan experience is beneficial. Prior experience with Medicare/Medicaid is a plus. Experience in call centers or triage is an added advantage. Bilingual candidates are encouraged to apply! Additional Information: Scheduled Weekly Hours: 40 This position is remote; however, occasional travel to Humana's offices for training or meetings may be required. Home Office Requirements: A high-speed DSL or cable modem is required (Satellite and Wireless Internet are NOT acceptable). Minimum performance standards: 25mbs download x 10mbs upload speed. Must have a dedicated office space free from distractions to meet productivity standards and ensure protection of member PHI/HIPAA information. Compensation: The estimated pay range for full-time (40 hours per week) employment is $71,100 - $97,800 per year, based on geographic location and individual qualifications. About Us: OneHome coordinates comprehensive post-acute care services, ensuring accountability for over one million health plan members nationwide. Acquired by Humana in 2021, OneHome is committed to advancing value-based care. We pride ourselves on an inclusive and diverse culture, dedicated to ensuring our employees feel engaged and supported. Humana Inc. is focused on prioritizing health for our teammates, customers, and community by making healthcare more accessible and enhancing quality of life for individuals and families. Equal Opportunity Employer: Humana values diversity and is dedicated to providing equal employment opportunities. We prohibit discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Created: 2026-03-04