Clinical UM Nurse
CenterWellAbout the role
Become a part of our caring community
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.
Use your skills to make an impact
Required Qualifications
- Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non compact licensure
- 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings)
- Work rotation to include weekends and possible holiday coverage required
- Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel)
Preferred Qualifications
- Previous experience in utilization management
- Education: BSN or bachelor's degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid experience
- Bilingual in English and Spanish
Additional Information
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:
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.
Scheduled Weekly Hours
40Pay Range
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 related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 08-01-2026
About us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the cApply for this role
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