Mid Level Utilization Management Specialist Jobs
Mid level utilization management specialist jobs go to clinicians and analysts ready to own case review workflows, apply independent clinical judgment, and guide teams through complex authorization decisions without constant oversight. Hiring runs across Insurance, Healthcare & Medical Services, and Education, with a strong mix of remote and on-site positions, and employers like Optum, Humana, and UF Health competing for utilization management specialists at this level now.
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Become a part of our caring community
The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
- Degree in Nursing
- Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.
- Ability to work independently.
Preferred Qualifications
- Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
- Managed Care, Medicaid or health plan experience
Workstyle: Remote Work at Home
Location: Indiana
Schedule: Monday through Friday 8:00-5:00 PM Eastern Time
Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.
$78,400 - $107,800 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, 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 Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
- Degree in Nursing
- Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.
- Ability to work independently.
Preferred Qualifications
- Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
- Managed Care, Medicaid or health plan experience
Workstyle: Remote Work at Home
Location: Indiana
Schedule: Monday through Friday 8:00-5:00 PM Eastern Time
Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.
$78,400 - $107,800 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, 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.
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Mid Level Utilization Management Specialist Jobs: Frequently Asked Questions
How do I get a mid level utilization management specialist job?
Position your experience around independent clinical decision-making, not just task completion. Highlight specific authorization workflows you have owned, criteria sets you have applied such as InterQual or Milliman, and any measurable outcomes you have driven, like denial reduction or turnaround improvement. Tailoring your resume to reflect scope of ownership, rather than a list of duties, is what separates mid level candidates from early-career applicants in this field.
Which companies hire mid level utilization management specialists?
Companies hiring mid level utilization management specialists right now include Optum, Humana, and UF Health, based on current listings on Migrate Mate as of November 2026. Health insurers, managed care organizations, and large hospital systems drive the most consistent hiring at this level, often seeking candidates who can work across multiple lines of business or care settings with limited supervision.
Are there remote mid level utilization management specialist jobs?
Yes, and the share is substantial for this role. About 75% of mid level utilization management specialist openings are remote or hybrid as of November 2026, reflecting how much of this work, including chart reviews, authorization determinations, and payer communication, can be performed entirely outside a clinical facility. Fully remote roles typically require reliable internet access and familiarity with care management platforms.
How do I move up to a mid level utilization management specialist role?
Getting to mid level means building depth in clinical criteria application, showing you can manage a caseload independently, and producing outcomes your team can point to. Over your first few years, seek exposure to different care settings, learn multiple utilization review criteria systems, and take ownership of quality or audit projects. Demonstrating that you flag issues proactively and influence decisions, rather than just executing instructions, is what earns mid level consideration.
Which industries hire the most mid level utilization management specialists?
Mid Level utilization management specialist roles concentrate in Insurance, Healthcare & Medical Services, and Education, based on current listings on Migrate Mate as of November 2026. These sectors drive demand because utilization management sits at the intersection of clinical care and cost containment, functions that health plans, managed care firms, and integrated delivery networks all need to staff with experienced, decision-ready clinicians rather than entry-level reviewers.