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Humana Rn Work From Home Jobs in Pittsburgh, PA (NOW HIRING)

HMG Careers

Work From Home Sales Specialist

Glasgow, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Irwin, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Oakland, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Trafford, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Carnegie, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Apollo, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

HMG Careers

Work From Home Sales Specialist

Industry, PA · Remote

$69K/yr

Remote, work-from-home career * Average first-year earnings of $69K through commissions and bonuses * Increased earning potential in later years through performance and renewals * Residual income ...

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Humana Rn Work From Home information

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$19

$43

$71

How much do humana rn work from home jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for humana rn work from home in Pittsburgh, PA is $43.19, according to ZipRecruiter salary data. Most workers in this role earn between $32.69 and $50.38 per hour, depending on experience, location, and employer.

What are the typical responsibilities and work structure for a Humana RN working from home?

As a Humana RN working from home, your daily responsibilities often include telephonic outreach to members, conducting health assessments, providing education on condition management, and coordinating care with other healthcare professionals. You may collaborate closely with interdisciplinary teams such as case managers, social workers, and physicians to ensure comprehensive support for patients. The work is generally structured around set shifts, with clear productivity and quality standards, but offers flexibility in managing your schedule. Remote RNs use secure digital platforms for documentation and communication, making time management and self-motivation essential skills.

What is a Humana RN Work From Home?

A Humana RN Work From Home job is a remote nursing position with Humana, a health insurance company. Registered Nurses (RNs) in these roles typically provide telephonic case management, care coordination, health assessments, and patient education to members. They use digital tools to monitor patient progress, collaborate with healthcare teams, and ensure members receive appropriate care, all from a home office. This position allows nurses to leverage their clinical expertise in a non-traditional, technology-driven work environment.

What are the key skills and qualifications needed to thrive as a Humana RN Work From Home, and why are they important?

To thrive as a Humana RN Work From Home, you need an active RN license, clinical experience, and a solid understanding of care management and telehealth protocols. Familiarity with telemedicine platforms, electronic health records (EHRs), and case management software is typically required. Strong communication, self-motivation, and organizational skills help you effectively support patients remotely and collaborate with healthcare teams. These capabilities are crucial for delivering high-quality patient care and meeting organizational goals in a remote work environment.

What is the difference between Humana Rn Work From Home vs Humana Licensed Practical Nurse (LPN) Work From Home?

AspectHumana Rn Work From HomeHumana Licensed Practical Nurse (LPN) Work From Home
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote, home-basedRemote, home-based
Employer & Industry UsageHealthcare insurance, managed care

Humana Rn Work From Home and Humana Licensed Practical Nurse (LPN) Work From Home roles both involve remote healthcare support, but RNs require a registered nurse license, while LPNs need an LPN license. Both positions are home-based and serve the healthcare insurance industry, with differences primarily in licensing requirements and scope of practice.

What are popular job titles related to Humana Rn Work From Home jobs in Pittsburgh, PA? For Humana Rn Work From Home jobs in Pittsburgh, PA, the most frequently searched job titles are:
What job categories do people searching Humana Rn Work From Home jobs in Pittsburgh, PA look for? The top searched job categories for Humana Rn Work From Home jobs in Pittsburgh, PA are:
What cities near Pittsburgh, PA are hiring for Humana Rn Work From Home jobs? Cities near Pittsburgh, PA with the most Humana Rn Work From Home job openings:
Humana Rn Work From Home jobs near you
Infographic showing various Humana Rn Work From Home job openings in Pittsburgh, PA as of July 2026, with employment types broken down into 1% As Needed, 73% Full Time, 22% Part Time, and 4% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $89,825 per year, or $43.2 per hour.

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)

The CKHobbie Group

Pittsburgh, PA • On-site, Remote

$40 - $42/hr

Full-time

PTO

Re-posted 16 days ago

Job description


Are you a registered nurse ready to take your career in an exciting newdirection-one where your expertise truly makes a difference? JoinPennsylvania's premier Quality Improvement Organization and step into adynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations,safeguard the quality of care, and influence healthcare outcomes on ameaningful scale. Enjoy the freedom of working from home, theflexibility and autonomy to manage your workday, and the opportunity forcontinuous professional growth-all while being part of a passionate,mission-driven team dedicated to improving healthcare across theCommonwealth.
In this rewarding role, you'll use your clinical knowledge outside ofthe traditional bedside setting to review and audit claims, supportprogram integrity initiatives, and advocate for beneficiaries across theCommonwealth. You'll enjoy the flexibility of working from home, theautonomy to manage your work, and meaningful opportunities forprofessional growth-all while contributing to a mission that trulymatters.
What You'll Do
  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For
  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records

Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required.
Why Join Us
  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work - enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work,professional growth, and the flexibility to balance your life andcareer-this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
• Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
• Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
• Possess basic computer skills, including familiarity with Microsoft Office programs.
Principal Duties and Responsibilities (RN - Utilization Review / Program Integrity)
  • Conduct clinical utilization reviews by evaluating medical records, treatment plans, and supporting documentation to determine medical necessity, appropriateness, quality, and level of care in accordance with Medical Assistance (MA) program requirements.
  • Apply nursing judgment and evidence-based clinical standards to ensure MA recipients receive safe, appropriate, and high-quality care while supporting program integrity and regulatory compliance.
  • Assess provider billing and documentation to verify compliance with MA policies and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic provider portals, telephone communications, fax, and U.S. mail, ensuring completeness and accuracy for utilization determinations.
  • Make authorization determinations by approving, modifying, or denying service requests within RN scope of practice, or refer cases to physician advisors for secondary medical review when medical necessity or level of care is unclear.
  • Collaborate with physician/medical consultants to support peer-to-peer reviews and facilitate discussions with ordering providers regarding clinical justification, appropriate care settings, and service coverage.
  • Accurately document utilization review decisions and clinical rationale in electronic systems, generating authorization notices, denial letters, reason codes, and appeal rights in compliance with regulatory standards.
  • Participate in retrospective, concurrent, and prospective utilization reviews, including re-evaluations of previously denied services upon request by providers or facilities.
  • Review and prepare appeal cases by analyzing medical records, developing exhibits and correspondence, and providing testimony at administrative hearings using knowledge of MA regulations, utilization management principles, and appeal processes.
  • Interpret MA policies, regulations, and utilization management guidelines for internal staff, providers, and stakeholders through consultation, meetings, and educational sessions.
  • Engage in interdisciplinary collaboration with internal departments, medical consultants, legal staff, and external stakeholders to support consistent and defensible utilization determinations.
  • Maintain ongoing professional development through continuing education, conferences, and review of current medical literature to remain current with standards of care, clinical guidelines, and utilization review best practices.
  • Provide cross-coverage in other program areas as needed, maintaining competency through training and updates to ensure continuity of program operations.
  • Respond to inquiries from recipients, providers, legislators, legal offices, and external agencies to explain utilization decisions, coverage policies, and administrative processes.
  • Maintain accurate case records and documentation in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated for each assignment.
  • When required, work at Department-designated locations. The primary duty location is Pittsburgh, PA, where appropriate workspace, technology, and resources will be provided to support assigned responsibilities.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

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