Become a part of our caring community and help us put health first
Are you ready to make a meaningful impact on patient outcomes and be a key player in care coordination?
Humana Healthy Horizons in Florida is seeking a dedicated Concurrent Utilization Management Nurse to join our collaborative team! In this dynamic role, you’ll leverage your clinical expertise to ensure members receive the right care at the right time—driving seamless transitions from hospital to home. Every day brings new challenges and opportunities to think critically, communicate effectively, and make independent decisions that truly matter. If you thrive in a fast-paced environment where your skills and judgment help shape healthier futures, we invite you to bring your passion and experience to
Humana Healthy Horizons.
The Concurrent Utilization Management Nurse is responsible for monitoring members throughout their hospital stay after initial hospitalization determination. This role ensures that care coordination and discharge planning are handled efficiently and in a timely manner.
Key responsibilities include:
- Continuously following members during their hospital admission to support effective care coordination and timely discharge.
- Applying clinical expertise, strong communication, and independent critical thinking to interpret relevant criteria, policies, and procedures, ensuring members receive the most appropriate care as they transition from the hospital.
- Coordinating and communicating with healthcare providers, members, and other involved parties to facilitate optimal care and treatment plans.
- Collaborating with outpatient providers to authorize any necessary post-hospital services for members.
- Exercising independent judgment in daily work, including making decisions in situations that may be unclear, while seeking guidance when needed.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree in nursing (BSN).
- Licensed Registered Nurse (RN) in Florida (or compact license) with no disciplinary action.
- 3 or more years of clinical nursing experience as an RN.
- Comprehensive knowledge of Microsoft Word, Outlook and Excel.
Preferred Qualifications
- Previous experience in utilization management.
- Medicare, Medicaid, and/or Health Plan experience.
Additional Information
- Workstyle: Remote work from home.
- Work Location: must reside in Florida.
- Typical work days/hours: Monday – Friday, 8:00am – 5:00 pm EST.
WAH Internet Statement
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:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- 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.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Limited Geography Remote - This is a remote position but located within a specific geography.
Travel: While this is a remote position, 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 yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
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.
Originally posted on Himalayas
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