Join our compassionate community and prioritize health like never before! The Behavioral Health Utilization Management Nurse plays a crucial role in utilizing clinical nursing expertise to enhance the coordination, documentation, and communication of behavioral health services. This position requires adaptability and the ability to independently determine appropriate courses of action across various work assignments. In this role, you will apply your clinical knowledge, communication, and critical thinking skills to interpret guidelines, policies, and procedures, ensuring members receive optimal care and services. You will collaborate with providers, members, and other stakeholders to facilitate the best possible treatment outcomes. A valid nursing license is essential to perform effectively in this role. You will need to understand the strategic objectives of the department and the broader organization, ensuring that your work aligns with various operational goals. Decision-making in this role will involve navigating sometimes ambiguous situations, working independently while also supporting team efforts. Utilize your skills to create a positive impact! Required Qualifications: Active and unrestricted registered nurse license. A minimum of one (1) year of post-degree clinical experience in patient care settings. At least one (1) year of experience in managed care. Proficient in Microsoft Office Suite and ability to navigate various systems to resolve technical issues remotely. Ability to work autonomously under general guidance as well as contribute to team dynamics. Exceptional oral, written, and interpersonal skills, alongside strong problem-solving and facilitation abilities. Preferred Qualifications: Experience with utilization review processes. Background in behavioral change, health promotion, coaching, and wellness. Familiarity with community health resources and support agencies. Additional Information: Workstyle: Remote Schedule: Minimum of 8 hours between 8:00 AM to 5:00 PM Eastern Time; may require rotating weekends or holidays based on business needs. To work effectively from home, your internet service must meet a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Please ensure that you have a dedicated workspace to protect member information in compliance with HIPAA guidelines. Application Deadline: 02-05-2026 About Us: Humana Inc. is dedicated to putting health at the forefront for our team, clients, and community. Through our diverse services, we strive to facilitate better health outcomes and enhance the quality of life for various populations. Equal Opportunity Employer: We are committed to a policy of nondiscrimination and equal opportunity for all employees and applicants. This includes all employment actions based solely on relevant job requirements.
