Manager, Utilization Management Nursing - Acute Care (Intermountain Region)

$84,600 - $116,300/Yr

Humana

Full-time - Manager

Remote

Insurance Carriers and Related Activities

About the position

The Manager, Utilization Management Nursing is responsible for overseeing the coordination and documentation of medical services and benefit administration determinations. This role requires the application of clinical nursing skills to ensure high-quality, cost-effective allocation of member services and resources. The Manager serves as a resource for the management team, members, and medical providers, while also managing staff performance and operational goals within the department.

Responsibilities

• Utilize clinical nursing skills to support coordination and documentation of medical services.
• Ensure high quality, cost-effective allocation of member services and resources.
• Manage attendance, schedules, and compliance expectations for adequate coverage.
• Provide oversight, education, and coaching to associates to meet performance expectations.
• Develop and monitor goals for staff, providing ongoing feedback and conducting performance reviews.
• Support daily management and operations of the department, overseeing utilization management functions.
• Implement policies and processes to maintain compliance with regulatory requirements.
• Analyze operational reports to monitor efficiency and track performance.
• Perform case reviews and document utilization management activities in electronic medical records.
• Function as a clinical resource for the multi-disciplinary care team.

Requirements

• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action.
• 3+ years of progressive clinical experience in an acute care, hospital, skilled, or rehabilitation setting.
• Utilization Management experience is required.
• Strong attention to detail and excellent time management skills.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Word, Outlook, and Excel.
• Ability to work independently and as part of a team.
• Passionate about improving consumer experiences.

Nice-to-haves

• Bachelor's degree in nursing (BSN).
• Prior supervisory or leadership experience.
• Experience in a team lead/SME or trainer/preceptor role.
• Health Plan experience.
• Previous Medicare experience.
• MCG experience.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off including personal holidays and volunteer time off.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.