[Hiring] Clinical Utilization Management Nurse @CenterWell

Role Description

As a Utilization Management Nurse 2, you will use clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. You will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Qualifications

• Active Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non-compact licensure
• 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• Prior clinical experience in acute care, skilled or rehabilitation clinical settings
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role)
• A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Must be willing to be in weekend rotation and possible holiday coverage

Requirements

• 3+ years of experience working in a high-volume and fast-paced environment
• Previous experience in utilization management
• Education: BSN or bachelor's degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience
• Call center or triage experience
• Bilingual English and Spanish (read/write/speak)

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Additional Information

• Self-provided internet service must meet the following criteria: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours

40

Pay 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.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Application Deadline

05-06-2026