Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
60 Humana Utilization Management Nurse Jobs Hiring Near You
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A ... You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical ...
Become a part of our caring community Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and ...
Become a part of our caring community Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and ...
Become a part of our caring community Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and ...
Become a part of our caring community Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and ...
Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license, (eNLC) with no ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Active Licensed Registered Nurse (RN) in Virginia or enhanced compact license, (eNLC) with no ... Humana reserves the right to require associates to upgrade their internet service if necessary.
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to ...
The Utilization Management Behavioral Health Professional 2 work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
The Utilization Management Behavioral Health Professional 2 work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
The Utilization Management Behavioral Health Professional 2 work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
The Utilization Management Behavioral Health Professional 2 work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Staff Utilization Management Clinical Pharmacist (VSP/PT)
$104K - $143K/yr
The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Educate providers on utilization and medical management processes. Enter and maintain relevant ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Educate providers on utilization and medical management processes. Enter and maintain relevant ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Certification in Healthcare Quality (CPHQ), Case Management (CCM), Utilization Management (CPUM ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Certification in Healthcare Quality (CPHQ), Case Management (CCM), Utilization Management (CPUM ... Humana reserves the right to require associates to upgrade their internet service if necessary.
Humana Jobs Information
What is it like to work at Humana?
Humana is a company that prioritizes a culture of compassion, empathy, and community involvement, striving to make a positive impact on people's lives. As a leading health and well-being company, Humana offers a dynamic work environment with diverse teams, opportunities for professional growth, and a mission-driven approach to improving healthcare outcomes. Working at Humana may appeal to candidates who are passionate about making a difference in healthcare and are motivated by the company's commitment to innovation, customer satisfaction, and employee development.
What makes Humana an attractive place to work?
Humana is a leading health and well-being company that has been a pioneer in the healthcare industry for over 60 years, with a strong commitment to improving the health and well-being of its members. The company offers a dynamic and supportive work environment that fosters collaboration, innovation, and professional growth, with opportunities for employees to work on cutting-edge projects and develop their skills in a stable and secure setting. By joining Humana, individuals can contribute to making a meaningful impact in the lives of millions of people, while also advancing their careers and achieving their personal and professional goals.
Do workers at Humana get paid breaks?
Yes. Most people get paid breaks.
78% of people say they get paid breaks.
Based on data from 77 people who took the Breakroom Quiz between August 2025 and August 2026.
78% of people say they get paid breaks.
Based on data from 77 people who took the Breakroom Quiz between August 2025 and August 2026.
Does Humana pay people when they’re sick?
Yes. Most people get paid when they’re sick.
77% of people say they would get paid if they were sick but scheduled to work.
Based on data from 94 people who took the Breakroom Quiz between August 2025 and August 2026.
77% of people say they would get paid if they were sick but scheduled to work.
Based on data from 94 people who took the Breakroom Quiz between August 2025 and August 2026.
At Humana, are sick days and vacation days separate paid time off?
Sick days and vacation days are used from the same paid time off.
92% of people say they have to use vacation days when they’re out sick.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
92% of people say they have to use vacation days when they’re out sick.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
Is the health insurance from Humana affordable enough for their workers?
Most people say the health insurance costs are okay.
88% of people say the health insurance costs are okay
Based on data from 82 people who took the Breakroom Quiz between August 2025 and August 2026.
88% of people say the health insurance costs are okay
Based on data from 82 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people get paid time off at Humana?
Most people get paid time off work.
94% of people say they get paid time off.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
94% of people say they get paid time off.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
How far ahead of time do people find out their work schedule?
Most people find out their schedule less than four weeks ahead of time.
Based on data from 49 people who took the Breakroom Quiz between December 2024 and May 2026.
- 47% of people with changing schedules find out their shifts one week or less ahead of time.
- 8% of people with changing schedules find out their shifts two weeks ahead of time.
- 16% of people with changing schedules find out their shifts three weeks ahead of time.
- 29% of people with changing schedules find out their shifts four weeks or more ahead of time.
Based on data from 49 people who took the Breakroom Quiz between December 2024 and May 2026.
Do workers at Humana worry about hours?
Most people don’t worry about getting enough hours.
93% of people report they don’t worry about getting enough hours.
Based on data from 163 people who took the Breakroom Quiz between December 2024 and August 2026.
93% of people report they don’t worry about getting enough hours.
Based on data from 163 people who took the Breakroom Quiz between December 2024 and August 2026.
Do Humana workers get to choose the shifts they work?
Some people don’t get to choose which shifts they work.
39% report that they don’t have enough control over which shifts they work.
Based on data from 38 people who took the Breakroom Quiz between June 2025 and June 2026.
39% report that they don’t have enough control over which shifts they work.
Based on data from 38 people who took the Breakroom Quiz between June 2025 and June 2026.
How easy is it for Humana workers to change shifts?
Some people find it hard to change shifts.
36% of people report that it’s hard to change shifts if they need to.
Based on data from 104 people who took the Breakroom Quiz between December 2024 and August 2026.
36% of people report that it’s hard to change shifts if they need to.
Based on data from 104 people who took the Breakroom Quiz between December 2024 and August 2026.
How easy is it to get time off at Humana?
Most people find it easy to get time off.
69% of people report it’s easy to get time off.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
69% of people report it’s easy to get time off.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
Do Humana managers change schedules at the last minute?
Most managers don’t change people’s schedules at the last minute.
96% of people say their manager doesn’t change their shift schedule at the last minute.
Based on data from 167 people who took the Breakroom Quiz between December 2024 and August 2026.
96% of people say their manager doesn’t change their shift schedule at the last minute.
Based on data from 167 people who took the Breakroom Quiz between December 2024 and August 2026.
Do jobs at Humana spill into time workers aren’t paid for?
Rarely. The job doesn't usually spill into unpaid time.
13% of people report that their job takes up time that they don’t get paid for.
Based on data from 163 people who took the Breakroom Quiz between December 2024 and August 2026.
13% of people report that their job takes up time that they don’t get paid for.
Based on data from 163 people who took the Breakroom Quiz between December 2024 and August 2026.
How easy is it to take sick days at Humana?
Most people find it easy to take sick days.
79% of people report that it’s easy to take time off if they are sick.
Based on data from 92 people who took the Breakroom Quiz between August 2025 and August 2026.
79% of people report that it’s easy to take time off if they are sick.
Based on data from 92 people who took the Breakroom Quiz between August 2025 and August 2026.
Is a Humana job good for students?
Most students say this is a good place to work if you’re studying.
83% of students report this is a good place to work if you’re studying.
Based on data from 24 people who took the Breakroom Quiz between January 2025 and July 2026.
83% of students report this is a good place to work if you’re studying.
Based on data from 24 people who took the Breakroom Quiz between January 2025 and July 2026.
Is working at Humana good if you’re a parent or caregiver?
Most parents and caregivers say this is a good place to work.
85% of people who care for a child or other relative report this is a good place to work.
Based on data from 48 people who took the Breakroom Quiz between August 2025 and August 2026.
85% of people who care for a child or other relative report this is a good place to work.
Based on data from 48 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people at Humana feel treated with respect by their managers?
Most people feel treated with respect by their managers.
91% of people say they’re treated with respect by their managers.
Based on data from 93 people who took the Breakroom Quiz between August 2025 and August 2026.
91% of people say they’re treated with respect by their managers.
Based on data from 93 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people at Humana get to take their breaks without interruption?
Most people get breaks without interruption.
90% of people report that they get to take their breaks without interruption.
Based on data from 88 people who took the Breakroom Quiz between August 2025 and August 2026.
90% of people report that they get to take their breaks without interruption.
Based on data from 88 people who took the Breakroom Quiz between August 2025 and August 2026.
Is it stressful to work at Humana?
Some people feel stressed here.
63% of people say they often feel stressed at work.
Based on data from 88 people who took the Breakroom Quiz between August 2025 and August 2026.
63% of people say they often feel stressed at work.
Based on data from 88 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people at Humana enjoy their jobs?
Most people enjoy their job.
74% of people report they enjoy their job.
Based on data from 90 people who took the Breakroom Quiz between August 2025 and August 2026.
74% of people report they enjoy their job.
Based on data from 90 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people at Humana recommend working with their team?
Only some people recommend working with their team.
39% of people report that they wouldn’t recommend working with their immediate team to a friend.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
39% of people report that they wouldn’t recommend working with their immediate team to a friend.
Based on data from 97 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people get enough training when they start at Humana?
Most people got enough training when they started.
75% of people report they got enough training when they started working here.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
75% of people report they got enough training when they started working here.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people get support to advance at Humana?
Only some people are given support to advance their career here.
In the last year, 34% of people report not being given support to advance their career here.
Based on data from 91 people who took the Breakroom Quiz between August 2025 and August 2026.
In the last year, 34% of people report not being given support to advance their career here.
Based on data from 91 people who took the Breakroom Quiz between August 2025 and August 2026.
Do people think Humana’s headquarters understands what’s happening where they work?
Most people think headquarters doesn’t understand what’s happening where they work.
72% of people think that this employer’s headquarters or owners don’t have a good understanding of what’s really happening where they work.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
72% of people think that this employer’s headquarters or owners don’t have a good understanding of what’s really happening where they work.
Based on data from 89 people who took the Breakroom Quiz between August 2025 and August 2026.
Do workers feel well informed about how Humana is doing?
Only some people feel well informed about how the company is doing.
34% of people feel that they aren’t kept well informed about how the company is doing as a whole.
Based on data from 91 people who took the Breakroom Quiz between August 2025 and August 2026.
34% of people feel that they aren’t kept well informed about how the company is doing as a whole.
Based on data from 91 people who took the Breakroom Quiz between August 2025 and August 2026.
What other companies are hiring for Utilization Management Nurse jobs?
What are the most popular jobs at Humana?
What are the most popular categories at Humana?
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 19 days ago
Humana rating
8.0
Based on 267 frontline employees who took The Breakroom Quiz
172nd of 315 rated insurance
Job description
Become a part of our caring community
The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action.
Use your skills to make an impact
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 atHumana.comand atCenterWell.com.
The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2) utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action.
Reporting to the Manager, Utilization Management Nursing, the Part C Grievance & Appeals (G&A) Nurse will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. You will review the medical documentation, researching claims, benefits, as well as prior determinations pertinent to the appeal and provides a written summary of findings using a template for each case. You will work and collaborate with Humana CIT teams, Vendors, G&A specialists, and Humana Medical Directors on submitted G&A cases. You will participate in initiatives which result in improved member outcomes, operational efficiencies, and process improvement opportunities.
- Case preparation of Medicare and/or Duals line of business involving expedited, pre-service and post service appeals
- Apply and implement Medicare, Medicaid, MCG, claims policy and evidence of coverage guidelines for reviews
- Perform outreach to providers and/or members
- Utilize multiple systems such as MHK, CGX, MRM, SRO
Use your skills to make an impact
Required Qualifications
- Associate's Degree
- Licensed Registered Nurse (RN) with compact license in the (appropriate state) with no disciplinary action
- 3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
Preferred Qualifications
- BSN or Bachelor's degree in a related field
- Appeal Review Experience
- Knowledge of MHK
- Medicare/Medicaid Experience
- Experience in utilization management
- Claims experience
- Leadership experience
Additional Information
- The Part C Grievance & Appeals (G&A) Nurse will be a Weekend Team Lead to support the Appeals team, with a strong focus on inventory management.
- This is a regular, full-time position covering Saturdays and Sundays weekly, with flexible weekday scheduling options.
- This role includes a required holiday rotation.
- This is a remote position.
- This role is responsible for overseeing weekend workflow, monitoring appeal inventory, prioritizing case assignments, and helping ensure timely and accurate processing in alignment with operational and compliance expectations.
- The Weekend Team Lead will serve as a resource for associates, provide real-time guidance, identify inventory risks and workload gaps, and escalate issues as needed. This position requires strong organizational skills, attention to detail, and the ability to balance production oversight with team support in a fast-paced environment.
Scheduled Weekly Hours
40Pay 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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 09-02-2026About 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 atHumana.comand atCenterWell.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