Remote Manager, Utilization Management Physical Health


  • Location Oklahoma

  • Job Type Full Time

  • Salary $84,600.00 – $105,800.00 ​
  • Experience 1-3 years
  • License
  • Date Posted October 30, 2023
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Location: OK
Location Type: Remote
Schedule: Full_time
Req: R-319529



The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.




Position Responsibilities

The Manager, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.

  • Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
  • Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
  • Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.


Reporting Relationship:

This role reports directly to the Associate Director, Utilization Management


Required Qualifications

  • An active Registered Nurse (RN) licensed in the state of Oklahoma without restrictions.
  • BSN, Bachelor’s degree in health services, healthcare administration, or business administration preferred.
  • 2+ years of clinical supervisory experience.
  • 2+ years of case management experience.
  • 3+ years of post-degree clinical experience in direct patient care.
  • Progressive clinical experience preferably in an acute care, skilled or rehabilitation setting.
  • Previous experience in utilization management.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.


Preferred Qualifications

  • Experienced with Milliman or Interqual criteria.


Additional Information


Work at Home Criteria  

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.


Our Benefits  

Health benefits effective day 1. Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
  • 401(k) retirement savings plan with employer match.
  • Tuition assistance, Scholarships for eligible dependents.
  • Parental and caregiver leave.
  • Employee charity matching program.
  • Network Resource Groups (NRGs).
  • Career development opportunities.  


  Interview Format  

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.  


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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$84,600.00 – $105,800.00 ​



Scheduled Weekly Hours