Utilization Management Registered Nurse - Compact ...

Join our dedicated team and help prioritize health! The Utilization Management Registered Nurse is essential in applying clinical nursing skills to coordinate, document, and communicate decisions regarding medical services and benefits. This position offers a variety of responsibilities that require keen interpretation and independent judgment in determining optimal courses of action. In this role, you will use your clinical expertise, strong communication skills, and critical thinking to interpret guidelines, policies, and procedures to provide the best possible treatment and care for our members. You will collaborate and communicate with healthcare providers, members, and various stakeholders to ensure the highest quality of care. It's vital to understand departmental and organizational strategies while making well-informed decisions with minimal supervision. Make a significant impact with your expertise! Required Qualifications: Active Registered Nurse (RN) license in the appropriate state with no disciplinary actions. Must possess a Compact License. Minimum of one year of clinical experience in an RN role within an acute care setting, ideally in specialty areas such as critical care, emergency room, or trauma units. Proficiency in Microsoft Word, Outlook, and Excel. Ability to work independently under general instructions, as well as collaboratively in a team environment. Enthusiastic about contributing to an organization focused on improving consumer experiences. Preferred Qualifications: Bachelor's degree in Nursing (BSN) or related field. Three or more years of clinical experience in acute care settings, particularly 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 plus a single-state RN license in non-compact states such as California, Hawaii, Nevada, or Oregon. Health plan experience is an asset. Previous experience with Medicare/Medicaid is beneficial. Experience in call centers or triage is helpful. Bilingual candidates are encouraged to apply. Additional Information: Scheduled Weekly Hours: 40 This is a remote position; however, occasional travel to Humana's offices for training or meetings may be necessary. Home Office Requirements: A high-speed DSL or cable modem is required for your home office (Satellite and Wireless Internet service are NOT acceptable). Minimum performance standards: 25mbs download x 10mbs upload speed. Must have a dedicated office space free from distractions to meet productivity requirements 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, depending on geographic location and individual qualifications. About Us: OneHome coordinates comprehensive post-acute care services, including home health, infusion therapy, and medical equipment services, ensuring integrated accountability for over one million health plan members nationwide. Acquired by Humana in 2021, OneHome is dedicated to advancing value-based care. Our culture is inclusive, diverse, and focused on care, ensuring our employees feel engaged and supported. Humana Inc. is committed to prioritizing health for our teammates, customers, and community, making healthcare more accessible for individuals and families while enhancing their quality of life. Equal Opportunity Employer: Humana values diversity and is committed to providing equal employment opportunities for all individuals. We prohibit discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Created: 2026-03-04