RN Care Management(Remote)

Become a part of our caring community

The Utilization Management RN will collaborate with other health care givers in reviewing medical care and services. This review will involve evaluating actual and proposed care against established CMS Coverage Guidelines/NCQA review criteria. You will be part of a team that focuses on excellent service to others. You will report to a Utilization RN Manager.

Active and unrestricted RN license with no disciplinary action

• 5+ years of clinical RN experience
• 5+ years of Acute Care experience in the Hospital ICU or ER settings
• Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience
• Experience cross training and floating among teams
• Available for On Call weekend/holiday rotation

BSN or bachelor's degree in a related field

Active and unrestricted Compact Registered Nurse (RN) license with no disciplinary action (including Nevada)

Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures

Experience in utilization management within Insurance industry

Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.

Bilingual in English and Spanish with the ability to read/write and speak in both languages

Travel for offsite Orientation for 2 to 8 weeks

Travel to offsite meetings up to 6 times a year

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

wireless, wired cable or DSL connection is suggested.

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

Application Deadline: 05-31-2026

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options