... for Humana's Utilization Management organization. This executive role is responsible for ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
... for Humana's Utilization Management organization. This executive role is responsible for ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Utilization Management Clinical Pharmacist 2 (Contract)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
Utilization Management Clinical Pharmacist 2 (Contract)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
Utilization Management
Reston, VA · Remote
Reston, VA (Remote) Duration: 3+ Months Contract PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre ...
New
Utilization Management
Reston, VA · Remote
Reston, VA (Remote) Duration: 3+ Months Contract PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre ...
New
Utilization Management Experience*** The Remote Medical Director works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social ...
Utilization Management Experience*** The Remote Medical Director works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social ...
The Remote UM Medical Director/ Physician Advisor (UM MD/PA) reports to the Senior VP of Clinical ... Utilization Management protocols, including auto-approvals and market specific protocols. • ...
The Remote UM Medical Director/ Physician Advisor (UM MD/PA) reports to the Senior VP of Clinical ... Utilization Management protocols, including auto-approvals and market specific protocols. • ...
Utilization Management Nurse
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...
Utilization Management Nurse
$80K - $95K/yr
Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost ... This is a fully remote role based in the United States. Sponsorship: This position is not eligible ...
Medical Director Utilization Management - Remote
Houston, TX · On-site +1
$248K - $373K/yr
The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...
Medical Director Utilization Management - Remote
Houston, TX · On-site +1
$248K - $373K/yr
The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...
Medical Director Utilization Management - Remote
Houston, TX · Remote
$248K - $373K/yr
The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...
Medical Director Utilization Management - Remote
Houston, TX · Remote
$248K - $373K/yr
The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · On-site +1
$80K - $156K/yr
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · On-site +1
$80K - $156K/yr
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
Be Seen First
Utilization Management Inpatient Coordinator
Orange, CA · Remote
$23 - $26/hr
Utilization Management Coordinator - Inpatient Review (Health Plan) Remote | Contract-to-Permanent Hire | Medicare Advantage We are seeking an experienced Utilization Management Coordinator ...
Quick apply
Be Seen First
Utilization Management Inpatient Coordinator
Orange, CA · Remote
$23 - $26/hr
Utilization Management Coordinator - Inpatient Review (Health Plan) Remote | Contract-to-Permanent Hire | Medicare Advantage We are seeking an experienced Utilization Management Coordinator ...
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · Remote
$80K - $156K/yr
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · Remote
$80K - $156K/yr
This position is remote and can be worked from a variety of locations within the US. Shift times ... utilization patterns and pharmacy costs management), clinical pharmacy services (such as ...
Location Requirements This position is remote but requires the employee to live within our service ... Payor Utilization Management: 3 years recommended experience * Proficiency with Microsoft Office ...
Location Requirements This position is remote but requires the employee to live within our service ... Payor Utilization Management: 3 years recommended experience * Proficiency with Microsoft Office ...
... Utilization Managers (RNUM ... These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ...
... Utilization Managers (RNUM ... These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ...
... Utilization Managers (RNUM ... These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ...
... Utilization Managers (RNUM ... These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ...
Review Utilization Management authorization request for medical necessity. * Evaluate ... Additionally, we embrace a remote-first culture that supports collaboration and flexibility ...
Review Utilization Management authorization request for medical necessity. * Evaluate ... Additionally, we embrace a remote-first culture that supports collaboration and flexibility ...
Medical Director - Utilization Management (Part Time)
Monterey Park, CA · On-site +1
$250K - $325K/yr
Medical Director - Utilization Management (Part Time) Department: HS - UM Employment Type ... This is a Remote - US based position. * The national target base salary range for this role is ...
Medical Director - Utilization Management (Part Time)
Monterey Park, CA · On-site +1
$250K - $325K/yr
Medical Director - Utilization Management (Part Time) Department: HS - UM Employment Type ... This is a Remote - US based position. * The national target base salary range for this role is ...
Medical Director - Utilization Management (Part Time)
Monterey Park, CA · Remote
$250K - $325K/yr
About the Role The PartTime Medical Director - Utilization Management, Outpatient Services provides ... This is a Remote - US based position. * The national target base salary range for this role is ...
Medical Director - Utilization Management (Part Time)
Monterey Park, CA · Remote
$250K - $325K/yr
About the Role The PartTime Medical Director - Utilization Management, Outpatient Services provides ... This is a Remote - US based position. * The national target base salary range for this role is ...
Description About the Role The Part‑Time Medical Director - Utilization Management, Outpatient ... This is a Remote - US based position. * The national target base salary range for this role is ...
Quick apply
Description About the Role The Part‑Time Medical Director - Utilization Management, Outpatient ... This is a Remote - US based position. * The national target base salary range for this role is ...
... community Humana Healthy Horizons is looking for a Utilization Management Behavioral Health ... Remote Work-at-Home (WAH)Internet Statement: To ensure Home or Hybrid Home/Office employees ...
... community Humana Healthy Horizons is looking for a Utilization Management Behavioral Health ... Remote Work-at-Home (WAH)Internet Statement: To ensure Home or Hybrid Home/Office employees ...
Humana Utilization Management Remote information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do humana utilization management remote jobs pay per hour?
As of Jun 10, 2026, the average hourly pay for humana utilization management remote in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.
What is the difference between Humana Utilization Management Remote vs Humana Utilization Review Nurse?
| Aspect | Humana Utilization Management Remote | Humana Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in utilization review |
| Work Environment | Remote, home-based | Typically remote or office-based, depending on employer |
| Employer & Industry | Humana, health insurance industry | Humana, health insurance industry |
| Primary Focus | Managing utilization requests remotely | Performing utilization reviews and assessments |
Both roles require RN licensure and utilization review certifications, often working remotely within the health insurance industry. The main difference lies in the job focus: Humana Utilization Management Remote emphasizes managing utilization requests remotely, while the Utilization Review Nurse involves performing detailed reviews and assessments. Both positions are integral to healthcare cost management and patient care coordination.
Humana rating
8.0
Based on 252 frontline employees who took The Breakroom Quiz
146th of 260 rated insurance
Job description
Become a part of our caring community
Provides executive leadership to Humana.
The Chief Medical Officer, Utilization Management (UM) will serve as the clinical strategist, operator, and visionary for Humana's Utilization Management organization. This executive role is responsible for integrating and overseeing all Outpatient and Inpatient based MDs and RNs and non-clinical support for UM functions in Medicaid and Medicare, with a focus on streamlining processes, ensuring consistent clinical practices, driving trend savings, improving Star Ratings, and enhancing operational efficiency. The CMO, UM will ensure alignment with Humana's strategic objectives and enterprise operating model.
Use your skills to make an impact
Key Responsibilities:
• Set clinical strategy and lead the Utilization Management organization.
• Oversee the integration of medical doctors and registered nurses in UM across Medicaid and Medicare.
• Provide leadership in risk management, grievance and appeals, clinical contracting, vendor management, and UM dental review.
• Ensure the clinician's perspective is central to organizational decision-making.
• Leverage analytics to inform strategy and performance improvement.
• Sponsor the development of clinical talent and leadership pipeline.
Organizational Scope:
The Chief Medical Officer, UM leads a significant functional organization, with direct accountability for human capital and organizational performance.
Direct reports include:
Role Impact:
• Drive the formation, execution, and sustainability of Humana's Utilization Management strategy.
• Challenge the healthcare status quo to improve quality, Star Ratings, and health outcomes.
• Integrate evidence-based approaches for UM reviewers.
• Support Humana's commitment to whole-person health and consistent, high-quality outcomes.
Candidate Qualifications:
• MD/DO
Current Board Certification
Minimum 10 years of combined leadership and/or UM experience.
• Passion for improving Star Ratings, review consistency, and health outcomes.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.
• Strong interpersonal, leadership, and business acumen.
• Proven ability to drive cross-functional results and champion clinical perspectives.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Application Deadline: 06-25-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Provides executive leadership to Humana.
The Chief Medical Officer, Utilization Management (UM) will serve as the clinical strategist, operator, and visionary for Humana's Utilization Management organization. This executive role is responsible for integrating and overseeing all Outpatient and Inpatient based MDs and RNs and non-clinical support for UM functions in Medicaid and Medicare, with a focus on streamlining processes, ensuring consistent clinical practices, driving trend savings, improving Star Ratings, and enhancing operational efficiency. The CMO, UM will ensure alignment with Humana's strategic objectives and enterprise operating model.
Use your skills to make an impact
Key Responsibilities:
• Set clinical strategy and lead the Utilization Management organization.
• Oversee the integration of medical doctors and registered nurses in UM across Medicaid and Medicare.
• Provide leadership in risk management, grievance and appeals, clinical contracting, vendor management, and UM dental review.
• Ensure the clinician's perspective is central to organizational decision-making.
• Leverage analytics to inform strategy and performance improvement.
• Sponsor the development of clinical talent and leadership pipeline.
Organizational Scope:
The Chief Medical Officer, UM leads a significant functional organization, with direct accountability for human capital and organizational performance.
Direct reports include:
- VP, Physician Leadership
- Director, Physician Leadership
- AVP, UM Nursing
- Lead Dental Director
- Director, Strategy Advancement
- AVP, UM Administration
Role Impact:
• Drive the formation, execution, and sustainability of Humana's Utilization Management strategy.
• Challenge the healthcare status quo to improve quality, Star Ratings, and health outcomes.
• Integrate evidence-based approaches for UM reviewers.
• Support Humana's commitment to whole-person health and consistent, high-quality outcomes.
Candidate Qualifications:
• MD/DO
Current Board Certification
Minimum 10 years of combined leadership and/or UM experience.
• Passion for improving Star Ratings, review consistency, and health outcomes.
• Deep knowledge of medical, clinical, and behavioral science underpinning UM.
• Strong interpersonal, leadership, and business acumen.
• Proven ability to drive cross-functional results and champion clinical perspectives.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Application Deadline: 06-25-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
About Humana
Sourced by ZipRecruiter
Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Louisville, KY, US
Year founded
1961