Utilization Management Manager

Humana

. Lead nurses and support staff responsible for utilization management and prior authorization activities .

Posted 9/18/2026full-timeRemote • Wisconsin • United StatesMid-LevelSenior💰 $94,900 - $130,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in utilization management, medical necessity, and prior authorization processes while leading clinical teams to ensure compliance with regulatory standards and improve operational performance. Proven ability to educate providers, manage resources, and drive process improvements in a healthcare setting.

Highest-signal resume keywords

Utilization Management ExperienceRegistered Nurse LicenseLeadership ExperienceExcel Macros DevelopmentClinical Documentation Management

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ManagementMedical Necessity ReviewsPrior AuthorizationProcess ImprovementTrend AnalysisOperational Performance MetricsClinical Information DocumentationTeam LeadershipQuality MonitoringRegulatory Compliance

Soft Skills

CollaborationCoachingCommunicationProblem-SolvingAccountability

Tools & Technologies

Medical Management SystemsExcel

Certifications & Qualifications

Registered Nurse License

Industry Keywords

HealthcareInpatient ServicesOutpatient ServicesBehavioral Health ServicesPHI/HIPAA Compliance

About the role

Key responsibilities & impact

Lead nurses and support staff responsible for utilization management and prior authorization activities
Oversee medical necessity and level-of-care reviews for inpatient, outpatient, and behavioral health services
Ensure authorization decisions comply with regulatory requirements and internal policies
Monitor productivity, quality, service levels, and operational performance metrics
Guide resolution and escalation of complex clinical and operational issues
Educate providers on utilization management, medical necessity, and prior authorization requirements
Oversee provider outreach activities
Ensure accurate entry, maintenance, and documentation of clinical information in medical management systems
Lead process improvement and trend analysis projects
Support departmental policies, procedures, and workflow standards
Collaborate with cross-functional partners to address operational challenges and improve outcomes
Conduct team meetings, coaching sessions, and performance discussions
Manage departmental resources and workflow
Promote accountability, quality, collaboration, and continuous improvement

Requirements

What you’ll need

Bachelor's degree
Active, unrestricted Registered Nurse license in Wisconsin or a compact state
3+ years of utilization management experience
2+ years of leadership experience managing clinical or operational teams
Experience writing complex macros for Excel
Monday–Friday availability, 8:00am–5:00pm Central Standard Time
Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental and caregiver leave
Short-term disability
Long-term disability
Life insurance
Dedicated home workspace arrangement
Remote work arrangement
Occasional travel to Humana offices for training or meetings