Utilization Management Registered Nurse – Home Health

Humana

. Utilize clinical nursing skills to support coordination, documentation, and communication of medical services and/or benefit administration determinations .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $71,100 - $97,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates clinical nursing expertise with a focus on patient care coordination, documentation, and communication. Proficient in navigating multiple systems while ensuring compliance with established guidelines and protecting patient information.

Highest-signal resume keywords

Licensed Registered Nurse (RN)Clinical Nursing SkillsPatient Care CoordinationTelephonic Communication SkillsMicrosoft Office Proficiency

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

Clinical ExperiencePatient CareDocumentationMedical Services CoordinationBenefit AdministrationClinical Information InterpretationIndependent Decision-MakingGuideline ComplianceGeriatric CareTelehealth

Soft Skills

CollaborationEffective CommunicationTeamworkIndependent WorkProblem-Solving

Tools & Technologies

Microsoft WordMicrosoft OutlookMicrosoft ExcelTelehealth Platforms

Certifications & Qualifications

Associate Degree in NursingCompact RN License

Industry Keywords

Patient OutcomesHome CareHIPAA ComplianceTelephonic SupportClinical Guidelines

About the role

Key responsibilities & impact

Utilize clinical nursing skills to support coordination, documentation, and communication of medical services and/or benefit administration determinations
Ensure fully coordinated care at home for members
Interpret clinical information and make recommendations to improve patient outcomes
Navigate multiple systems and screens while working cases
Interact and collaborate with internal and external parties
Make independent determinations regarding appropriate courses of action
Follow established guidelines, processes, and procedures
Occasionally travel to Humana offices for training or meetings

Requirements

What you’ll need

Minimum of Associate Degree in nursing
Licensed Registered Nurse (RN) in a compact state with no disciplinary action
Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure
Three (3) or more years of progressive and varying clinical experience including direct patient care to geriatric population
Effective telephonic and virtual communication skills
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team
High-speed DSL or cable modem for a home office; satellite and wireless internet service is not allowed
Minimum internet speed of 25 Mbps download and 10 Mbps upload
Dedicated office space without ongoing interruptions to meet productivity requirements and protect member PHI/HIPAA information
Ability to work Monday–Friday, 8:00am–5:00pm Eastern Standard Time

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance