[Remote] RN, Manager, Utilization Management Nursing at Humana

The Manager, Utilization Management Nursing will lead and oversee physical health utilization management staff, using clinical knowledge and critical thinking to interpret criteria, policies, and procedures for optimal member care. Responsibilities include hiring, training, coaching, and evaluating staff, as well as implementing and maintaining processes compliant with MDHHS and NCQA guidelines. This role involves assessing and mitigating inefficiencies, collecting and analyzing data to improve operational metrics and performance, and coordinating with providers and members to facilitate care. The manager will also make decisions regarding resources and tactical operations, facilitate cross-departmental collaboration, and conduct departmental briefings and meetings.