Utilization Management Nurse

CarePlus Health Plans Inc

Remote, US
Base: $71,100 - $97,800 py; bonus: eligible for co...
Hybrid
Active rn license in virginia or enlc state
2 years prior utilization management experience
Intermediate to advanced microsoft office skills
CarePlus Health Plans Inc. is seeking a Utilization Management Nurse to work remotely, utilizing clinical nursing skills for the coordination and documentation of medical services. The ideal candidate should have a valid RN license, at least two years of utilization management experience, and proficiency in Microsoft Office

Job Summary

  • The Utilization Management Nurse uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations.
  • Humana offers competitive benefits including medical, dental, vision, 401(k) retirement savings, paid time off, and a bonus incentive plan based on performance.
  • This remote position requires working a minimum of 8 hours between 8:00 AM to 5:00 PM Eastern Time with less than 5% travel for onsite meetings.

Matching Summary

Match Score: 85

CarePlus Health Plans Inc. is seeking a Utilization Management Nurse to work remotely, utilizing clinical nursing skills for the coordination and documentation of medical services. The ideal candidate should have a valid RN license, at least two years of utilization management experience, and proficiency in Microsoft Office.

Salary

Base: $71,100 - $97,800 per year; Bonus: Eligible for company/individual performance incentive; Benefits: Medical, dental, vision, 401(k), PTO, parental leave

Skills & Requirements

Must-have

  • Active RN license in Virginia or eNLC state
  • 2 years prior utilization management experience
  • Intermediate to advanced Microsoft Office skills
  • Ability to work independently in remote environment
  • Strong oral, written, and interpersonal communication

Nice-to-have

  • BSN degree preferred
  • Experience with MCG/InterQual tools
  • Health plan and Medicare/Medicaid experience
  • Problem-solving and facilitation skills
  • Team collaboration in ambiguous situations

Key Requirements

  • Active RN license (Virginia or eNLC)
  • 2+ years utilization management experience
  • No disciplinary action on license
  • Reside in eNLC participating state
  • Internet speed 25 Mbps download / 10 Mbps upload

Work Rights

Must reside in a state participating in the enhanced nurse compact licensure (eNLC)

Tailored Resume

Cover Letter