(WFH) Clinical Auditor RN Utilization Management, Remote Nationwide-id-9254

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Clinical Auditor RN – Utilization Management (Remote)

Location: Nationwide (Must reside in an eNLC state)
Schedule: Full-Time, Monday–Friday, 8:30 AM – 6:00 PM ET (Flexible with leadership approval)
Pay Range: $71,100 – $97,800 per year + Bonus Incentive Plan
Application Deadline: July 1, 2025

Put Health First — Join Humana’s Remote Nursing Team

At Humana, we’re committed to putting health first—for our teammates, customers, and communities. We’re looking for a Compliance Nurse 2 (Clinical Auditor RN) to join our Utilization Management team, working remotely to ensure the highest standards of care and compliance in healthcare delivery.

If you have a passion for clinical excellence, data-driven decision making, and independent judgment, this role offers an exciting chance to make a meaningful impact on patient outcomes while working from home.

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What You’ll Do

  • Review utilization management activities and documentation for compliance with policies, procedures, and regulations

  • Detect and prevent fraud, waste, and abuse

  • Conduct and summarize compliance audits, analyzing operational and outcome metrics daily, weekly, or as needed

  • Ensure all mandatory reporting is completed accurately and timely

  • Work independently with occasional guidance, interpreting complex information and making sound decisions

  • Collaborate to understand and support organizational strategy and objectives

What You Bring

  • Active RN license in an Enhanced Nursing Licensure Compact (eNLC) state, with ability to obtain additional licenses without restrictions

  • Minimum of 3 years clinical nursing experience

  • At least 1 year auditing, case management, or utilization management experience

  • Proficient with Microsoft Office (Word, Excel, PowerPoint) and comfortable navigating multiple systems remotely

  • Ability to work independently and in teams, with strong organizational and analytical skills

Preferred Qualifications

  • Bachelor of Science in Nursing (BSN)

  • Experience with large health plans and Medicare/Medicaid programs

  • Familiarity with utilization management, case management, discharge planning, home health, or rehab

  • Certified Case Manager (CCM) and/or MCG Certification

  • Experience with MCG or InterQual guidelines

Why Work at Humana?

  • Fully remote work: Work from a dedicated home space that supports HIPAA compliance

  • Comprehensive benefits: Medical, dental, vision, 401(k) with company match, paid time off, parental leave, life insurance, disability coverage, and more

  • Professional growth: Opportunities for continuous learning and career advancement

  • Meaningful work: Support the health and well-being of millions of Humana members

Additional Details

  • Must maintain a quiet, distraction-free home workspace with reliable internet (minimum 25 Mbps download, 10 Mbps upload recommended)

  • Occasional travel (1-2 times/year) for meetings or training

  • Participation in an innovative voice-recorded interview process (Modern Hire Voice) for initial screening

Apply Now and Make a Difference with Humana!

Help us create healthier futures—apply today by July 1, 2025. We look forward to learning how your skills and experience can support our mission to serve millions across the country.

Humana is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

(WFH) Clinical Auditor RN Utilization Management, Remote Nationwide-id-9254

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