Concurrent Utilization Management RN

About the Role

Employment Type: Full time

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.

Key Responsibilities

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.

• 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.

Workstyle and Location

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).