Utilization Management Compliance Registered Nurse, RN

Are you a passionate and detail-oriented Registered Nurse (RN) looking for a challenging and rewarding career opportunity? Look no further! Humana is seeking a Utilization Management Compliance RN to join our dynamic team. In this role, you will be responsible for ensuring compliance with all utilization management policies and procedures, while utilizing your clinical expertise and critical thinking skills to improve the quality of care for our members. If you have a strong background in utilization management, are dedicated to upholding regulatory standards, and are committed to providing exceptional patient care, we want to hear from you!

1. Ensure compliance with all utilization management policies and procedures.
2. Utilize clinical expertise and critical thinking skills to improve the quality of care for members.
3. Uphold regulatory standards related to utilization management.
4. Collaborate with other departments and team members to ensure proper utilization management processes are followed.
5. Conduct audits and reviews to identify areas for improvement and ensure adherence to policies.
6. Develop and implement strategies to enhance utilization management processes and outcomes.
7. Serve as a resource for staff regarding utilization management policies and procedures.
8. Monitor and analyze data to identify trends and opportunities for improvement.
9. Provide education and training to staff on utilization management best practices.
10. Participate in utilization management meetings and committees to provide input and make recommendations.
11. Maintain accurate records and documentation related to utilization management compliance.
12. Communicate effectively with patients, providers, and other stakeholders to ensure proper utilization management processes and compliance.
13. Stay updated on industry trends and regulations related to utilization management.
14. Adhere to ethical and professional standards in all utilization management activities.
15. Provide exceptional patient care and promote member satisfaction through utilization management practices.

According to JobzMall, the average salary range for a Utilization Management Compliance Registered Nurse, RN is between $65,000 and $85,000 per year. This can vary depending on factors such as location, years of experience, and specific job duties. Nurses with advanced degrees or certifications may also earn higher salaries.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.