Utilization Management Registered Nurse in Indianapolis, IN

Join our compassionate team and help prioritize health The Utilization Management Registered Nurse plays a vital role in utilizing clinical nursing expertise to enhance the coordination, documentation, and communication of medical services or benefit administration determinations. This position requires varied work assignments that involve interpreting information and making independent decisions on the appropriate courses of action. As a Utilization Management Registered Nurse, you will apply your clinical knowledge, communication skills, and critical thinking abilities to interpret criteria, policies, and procedures. Your goal will be to ensure members receive the best and most appropriate treatment, care, or services. You will coordinate and communicate effectively with providers, members, and other stakeholders to facilitate optimal care. Understanding departmental and organizational strategies is crucial as you make decisions regarding your work methods with minimal direction while following established guidelines and procedures. Make a difference with your skills Required Qualifications • Current Registered Nurse (RN) license with no disciplinary actions. • At least 3 years of clinical nursing experience in an acute care setting. • Competency in using Microsoft Word, Outlook, and Excel. • Previous experience working both independently and collaboratively in a team environment. Preferred Qualifications • Education: BSN or a bachelor’s degree in a related field. • Experience in a Health Plan environment. • Background in utilization management or related activities ensuring appropriateness of care. • Previous experience with Medicare is a plus. • Familiarity with Milliman MCG guidelines is preferred. Additional Information • Work hours: Monday-Friday, 8am-5pm (Various Time Zones) Remote Work Requirements: To ensure effective performance, associates working from home must provide internet service that meets these criteria: a minimum download speed of 25 Mbps and an upload speed of 10 Mbps, preferably through a wired, cable, or DSL connection. Approval is needed for satellite, cellular, or microwave connections. Associates in California, Illinois, Montana, or South Dakota will receive bi-weekly payments for internet expenses. Humana will supply appropriate telephone equipment to meet business requirements, and you must work from a dedicated, interruption-free space to protect member privacy (PHI / HIPAA compliance). Why Join Us? • Comprehensive benefits starting on day 1. • Competitive 401k match. • Generous Paid Time Off accrual. • Tuition Reimbursement opportunities. • Paid parental leave. • A variety of wellness perks. Interview Process As part of our hiring process, we utilize an interviewing technology called HireVue to enhance our decision-making ability. This platform allows for a flexible connection and assessment of your skills and experience at your convenience. Travel Expectations: This is a remote position; however, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Salary Information The salary range reflects a good faith estimate of base pay for full-time (40 hours per week) employment at the time of posting and is subject to variation based on geographic location and individual qualifications. Annual salary: $71,100 - $97,800 with eligibility for a bonus incentive plan based on performance. About Humana Humana Inc. is dedicated to prioritizing health for our associates, customers, and the broader community. Through our insurance and healthcare services, we strive to make it easier for millions to achieve their health goals and enhance their quality of life. Equal Opportunity Employer Humana is committed to preventing discrimination in all employment practices based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We also take active steps to employ and advance individuals with disabilities or protected veteran status, ensuring all decisions are made based on valid job requirements.