Full-Time
Utilization Management Registered Nurse
One Home/Home Solutions Utilization Management
Updated on 9/11/2026
Humana
10,001+ employees
Medicare Advantage health insurer for seniors
Compensation Overview
$71.1k - $97.8k/yr
New Mexico, USA + 36 more
More locations: Washington, USA | Kansas, USA | Pennsylvania, USA | Delaware, USA | Iowa, USA | Vermont, USA | Wyoming, USA | Texas, USA | Montana, USA | Florida, USA | New Hampshire, USA | South Carolina, USA | South Dakota, USA | Georgia, USA | Arizona, USA | Mississippi, USA | Tennessee, USA | Virginia, USA | Arkansas, USA | Colorado, USA | Nebraska, USA | Rhode Island, USA | Utah, USA | Kentucky, USA | West Virginia, USA | Maryland, USA | Wisconsin, USA | Maine, USA | Oklahoma, USA | Missouri, USA | Ohio, USA | New Jersey, USA | Indiana, USA | Louisiana, USA | Alabama, USA | Idaho, USA
Remote
Remote within the listed states; occasional travel to Humana offices for training or meetings may be required.
Bachelor's
 Medical, Clinical & Veterinary |
|---|
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- Must hold a Compact Registered Nurse license in the state of residence.
- Must have more than one year of clinical experience as a registered nurse in a hospital, skilled nursing facility, home health, or acute care setting.
- Must be able to work from a dedicated space without ongoing interruptions to protect member protected health information and HIPAA information.
- Must have home internet with at least 25 Mbps download speed and 10 Mbps upload speed.
- Must work 40 scheduled hours per week.
- Use clinical nursing skills to interpret and support the coordination, documentation, and communication of medical services and benefit administration determinations.
- Use established medical criteria to make determinations based on information provided by attending physicians and other care providers.
- Complete request determinations within established processing time frames.
- Communicate with providers, members, and other parties to facilitate care and treatment.
- Help deliver coordinated care for members.
- Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
- Previous experience in utilization management or utilization review for a health plan or acute care setting.
- Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or InterQual.
- Experience working in a fully remote, metrics-focused role.
- Experience as an MDS Coordinator or discharge planner in an acute care setting.
- Experience as a registered nurse for a Medicare-certified home health agency.
- Health plan or Medicare/Medicaid experience.
- Call center or triage experience.
- A BSN or bachelor's degree in a related field.
Humana focuses on health and well-being by offering Medicare Advantage plans (HMO, PPO, and PFFS) mainly for seniors, military personnel, and communities. Its products are health insurance plans funded through a mix of government contracts and member premiums, enrolling members to provide comprehensive coverage with flexible benefits and a broad provider network. Members receive care through a network of providers, with additional services such as free language interpretation to improve accessibility. Humana differentiates itself through its emphasis on inclusivity, accessibility, and tailored benefits, aiming to deliver reliable service and high renewal rates. The goal is to improve health outcomes and overall well-being for members by delivering coverage that meets diverse needs and making care accessible to all.
Company Size
10,001+
Company Stage
IPO
Headquarters
Louisville, Kentucky
Founded
1961
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Simplify's Take
What believers are saying
- Second-quarter 2026 revenue reached $40.87 billion, up 26.2%, beating estimates.
- Illinois awarded Humana a statewide Medicaid contract starting January 2027, broadening state footing.
- Humana expects 2027 MA membership growth of roughly 25%, despite plan exits.
What critics are saying
- CMS star-rating losses cut 2026 GAAP EPS guidance to at least $6.52.
- 2027 plan exits hit 600,000 members, risking churn and weaker brand trust.
- Texas appeal loss or further CMS downgrades can erase billions in MA bonuses.
What makes Humana unique
- Humana leads Medicare Advantage with 6.45 million individual MA members in 2026.
- CenterWell and Medicaid expansion add care delivery and government-contract diversification beyond insurance.
- August 2026 board adds Anthropic's Paul Smith, signaling faster AI-enabled care operations.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
Unlimited Paid Time Off
Paid Vacation
Paid Parental Leave
Short-term Disability
Long-term Disability
401(k) Retirement Plan
401(k) Company Match
Wellness Program
Growth & Insights and Company News
6 month growth
↑ 6%1 year growth
↑ 6%2 year growth
↑ 6%Thyme Care, a Nashville-based oncology company, has closed a Series E funding round of more than $125 million at a valuation exceeding $2 billion. Morgan Health led the round, with participation from CVS Health Ventures, Humana, AlleyCorp, HealthQuest Capital, Foresite Capital, Concord Health Partners, Frist Cressey Ventures, Town Hall Ventures, and a16z Bio + Health. The company now serves over 10.5 million people across all 50 US states and manages more than $7 billion in oncology spend. Thyme Care reports it is profitable with positive free cash flow whilst delivering validated reductions of 5 to 10 per cent in total cost of care. Alongside the funding, Thyme Care is establishing Thyme Companies, a parent entity that will build a portfolio of independent oncology businesses addressing care barriers. Co-founder Robin Shah will serve as executive chairman of the new entity.
Humana has appointed Dr Shantanu Nundy as Chief Medical Officer, effective 31 August. Dr Nundy, a practicing physician and healthcare executive, will help shape the company's products, platforms, and use of AI whilst bringing clinical expertise to the enterprise. He most recently served as Executive Vice President of Care Delivery and Chief Health Officer at Accolade, a healthcare navigation company. Previously, he was Managing Director for Clinical Innovation at Evolent Health, driving value-based and digital care transformation across health systems. Dr Nundy will report to Jim Rechtin, Humana's President and CEO, and join the company's Enterprise Leadership Team. He continues to practice primary care and hospital medicine.
Humana reported Q2 revenues of $40.87 billion, up 26.2% year on year, exceeding analysts' expectations by 0.6%. The health insurance provider also beat earnings per share estimates. Despite the relatively strong results, Humana's stock has fallen 2.7% since the earnings announcement and currently trades at $378.11. The health insurance sector as a whole showed resilience in Q2, with the 12 tracked providers beating revenue consensus estimates by 2.8% on average. However, share prices across the sector have declined an average of 5.8% since reporting. Humana derives over 80% of its revenue from federal government contracts and serves approximately 17 million members, with a strong focus on Medicare Advantage plans for seniors.
Nearly 3 million older Americans will lose their Medicare Advantage plans this year, according to Johns Hopkins Bloomberg School of Public Health research. One in 10 Medicare Advantage policyholders face forced disenrollment, with Vermont hit hardest at 92% of policyholders affected. Humana announced its exit from multiple markets for the second consecutive year, impacting 600,000 members. The company reported $1.9 billion profit in the first half of 2026. Insurers cite financial pressures from federal policy changes aimed at reducing overpayments, resulting in lower government reimbursement rates. Combined with rising medical costs, these factors are squeezing profit margins. Shannon Benton of Senior Citizens League said Humana's decision shows Medicare Advantage insurers are "prioritising profit growth over enrollment growth.
Nine pharmacy benefit managers will integrate TrumpRx prescription drug pricing into their benefit tools, effective 1 January 2027. The Pharmaceutical Care Management Association and participating PBMs—including CVS Health, Express Scripts, Humana, and OptumRx—will display cash prices from TrumpRx alongside plan coverage costs. The agreement covers commercial, Medicare, and Medicaid plans. Patients will see TrumpRx prices for all listed drugs, whether through presidential deals or standard pricing. CMS Administrator Dr Mehmet Oz said the commitment will help patients compare prices and find better deals. PCMA CEO David Marin stated the transparency will allow consumers to make better-informed choices about prescription drug costs. Some PBMs will use Real Time Benefit Tools to display pricing comparisons, whilst others may employ different methods.