Utilization Management Nurse – Remote (SC)

About the role

The Utilization Management Nurse supports the coordination, documentation, and communication of medical services and benefit determinations for members. Working remotely with occasional travel to Columbia, SC, you will apply clinical expertise to ensure appropriate care pathways while reporting to the Manager of Utilization Management.

Key responsibilities

• Interpret clinical criteria, policies, and procedures to determine appropriate treatment and services.
• Coordinate and communicate with providers, members, and other stakeholders to facilitate optimal care.
• Document and support benefit administration determinations.
• Follow established guidelines and departmental strategies.
• Report findings and recommendations to the Utilization Management Manager.

Required profile

• Licensed Registered Nurse (RN) in South Carolina with no disciplinary action.
• Minimum 3 years of experience in medical‑surgery, cardiac, pulmonary, or critical‑care nursing.
• Residency in South Carolina and ability to work rotational weekends.
• Prior utilization management experience, preferably in an acute‑care, skilled‑nursing, or rehabilitation setting.
• Proficiency with Microsoft Word, Outlook, and Excel.

Required skills

• Microsoft Word
• Microsoft Outlook
• Microsoft Excel

What we offer

• Fully remote work schedule (M‑F 8 am‑5 pm EST) with required weekend rotations.
• Occasional travel (up to 10%) to the Columbia, SC office.
• Home office equipment and bi‑weekly internet stipend for eligible states.
• Access to Humana’s health‑care benefits and professional development resources.