Utilization Management Nurse Jobs at Humana with Visa Sponsorship
Utilization Management Nurses at Humana review clinical cases, make coverage determinations, and work closely with care teams across its managed care and insurance lines. Humana has a established record of sponsoring work visas for qualified nurses in this function, supporting candidates through multiple visa pathways.
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The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
As a Utilization Management Registered Nurse:
- You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
- Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers.
- You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
- You will communicate with providers, members, or other parties to facilitate care and treatment.
- You will help deliver coordinated care for our members.
- You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Use your skills to make an impact
Required Qualifications:
- Must hold Compact Registered Nurse (RN) license in your state of residence.
- Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
- Must be passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications:
- Previous experience in utilization management/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 an RN for a Medicare Certified Home Health agency.
- Health Plan or Medicare / Medicaid Experience.
- Call center or triage experience.
- BSN or bachelor's degree in a related field.
Additional Information
Work-at-Home Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay 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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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.
Become a part of our caring community
The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
As a Utilization Management Registered Nurse:
- You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
- Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers.
- You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
- You will communicate with providers, members, or other parties to facilitate care and treatment.
- You will help deliver coordinated care for our members.
- You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Use your skills to make an impact
Required Qualifications:
- Must hold Compact Registered Nurse (RN) license in your state of residence.
- Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
- Must be passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications:
- Previous experience in utilization management/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 an RN for a Medicare Certified Home Health agency.
- Health Plan or Medicare / Medicaid Experience.
- Call center or triage experience.
- BSN or bachelor's degree in a related field.
Additional Information
Work-at-Home Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay 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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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.
See all 36+ Utilization Management Nurse at Humana jobs
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Get Access To All JobsTips for Finding Utilization Management Nurse Jobs at Humana Jobs
Obtain Your RN License Before Applying
Humana's utilization management roles require an active, unrestricted RN license in the state where you'll work. Get your license endorsed or transferred early, since USCIS and Humana's HR team will both verify this before any petition moves forward.
Highlight Clinical Review Experience in Applications
Humana screens utilization management candidates for hands-on experience with InterQual or MCG criteria, prior authorization workflows, and denial rationale documentation. Frame your resume around these specifics rather than bedside nursing duties to clear their initial screening filters.
Target Humana's Remote UM Postings Strategically
Many of Humana's utilization management nurse roles are posted as remote positions tied to specific state licensure requirements. Search by state rather than city, and confirm the posting explicitly lists visa sponsorship availability before submitting your application.
Confirm Sponsorship Eligibility During the Interview
Ask Humana's recruiter directly whether the specific UM role falls under a cost center that supports visa sponsorship. Large managed care employers sometimes ring-fence sponsorship budgets to certain business units, so verbal confirmation early saves you from surprises after an offer.
Use Migrate Mate to Filter Verified Sponsorship Openings
Not every Humana posting that mentions 'open to sponsorship' reflects an active filing program. Use Migrate Mate to browse Humana's utilization management nurse openings verified against their actual sponsorship history, so you're applying where approval pathways are real.
Understand the TN Visa Option if You're Canadian or Mexican
Registered nurses from Canada or Mexico can pursue TN status for UM roles without waiting on the H-1B lottery. Humana's legal team is familiar with TN petitions for clinical roles, so flag your nationality early in the offer stage to align on the right filing path.
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Find Utilization Management Nurse at Humana JobsFrequently Asked Questions
Does Humana sponsor H-1B visas for Utilization Management Nurses?
Yes, Humana sponsors H-1B visas for Utilization Management Nurses. Utilization management is classified as a specialty occupation under USCIS guidelines because it requires applying specialized nursing and clinical judgment within structured managed care frameworks. Sponsorship availability can vary by business unit and posting, so confirm with the recruiter that the specific role you're applying to carries an active sponsorship budget before accepting an offer.
How do I apply for Utilization Management Nurse jobs at Humana?
Apply through Humana's careers portal at careers.humana.com, searching for utilization management or UM nurse roles. You can also browse verified sponsorship-eligible postings on Migrate Mate to filter specifically for Humana openings where visa sponsorship has been confirmed. Tailor your application to highlight prior authorization experience, familiarity with clinical review criteria like InterQual or MCG, and your active state RN license.
Which visa types does Humana commonly use for Utilization Management Nurse roles?
Humana files H-1B petitions most frequently for utilization management nurses, given the specialty occupation classification. TN status is an option for Canadian and Mexican RNs. F-1 OPT and CPT can cover early employment periods for recent nursing graduates, though clinical UM roles typically require experience that OPT candidates may need to build first. EB-2 and EB-3 immigrant visa sponsorship is also available for longer-term employment.
What qualifications does Humana expect for Utilization Management Nurse candidates?
Humana typically looks for an active, unrestricted RN license, at least two to three years of clinical nursing experience, and demonstrated knowledge of utilization review processes including prior authorization and concurrent review. Familiarity with InterQual or MCG clinical criteria is frequently listed as a requirement. Case management or managed care experience in an insurance or health plan setting strengthens your candidacy significantly compared to candidates with only hospital floor backgrounds.
How do I handle the H-1B lottery timeline when applying to Humana for a UM Nurse role?
H-1B registration opens in March each year, with the lottery typically completing by late March and petition filing deadlines in April for an October 1 start date. If you're on F-1 OPT, plan your application timeline so you have an active OPT authorization that bridges the gap to October 1. Humana's legal team can file for cap-exempt status if you previously held H-1B status at a qualifying employer, which bypasses the lottery entirely.
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