Become a part of our caring community and help us put health first

The UM/PA Nurse Supervisor plays a key leadership role in overseeing the daily operations of the Utilization Management and Pre-Authorization nursing teams. This position ensures timely and accurate review of medical necessity and appropriateness of care, in alignment with clinical guidelines, regulatory requirements, and organizational policies. The Supervisor provides frontline support to nursing staff, facilitates interdepartmental collaboration, and assists in managing workload distribution and performance metrics.

In addition to supervising clinical review processes, the UM/PA Nurse Supervisor contributes to staff development, quality improvement initiatives, and operational efficiency. This role serves as a liaison between clinical teams, providers, and internal stakeholders, ensuring a high standard of service delivery and compliance.

• Provide daily operational support and guidance to Utilization Management (UM) and Pre-Authorization (PA) nursing staff.
• Conduct monthly one-on-one check-ins with team members to support performance, development, and engagement.
• Maintain and update staff training materials and departmental resources to ensure consistency and compliance.
• Coordinate updates to letter templates in collaboration with Compliance, Network Development, and IT, ensuring alignment with CMS and DHS requirements and proper integration into TruCare.
• Support NCQA re-accreditation efforts by implementing updated processes and policies to meet accreditation standards.
• Assist in leading bi-weekly departmental and team meetings to promote communication, alignment, and continuous improvement.
• Review PA requests for services including home health, durable medical equipment, outpatient therapies, skilled nursing facility therapies, and outpatient procedures, ensuring compliance with Medicare, Medicaid, iCare guidelines, and departmental policies.
• Evaluate PA requests for inpatient stays (acute, skilled nursing, LTAC, and rehabilitation) in accordance with Humana/iCare protocols, and collaborate with discharge planners, care coordinators, and behavioral health staff to support member transitions.
• Monitor inpatient and subacute activity daily, assessing outcomes related to readmissions, utilization, quality of care, and provider performance in accordance with organizational policies.
• Document clinical decisions accurately, including rationale for approvals or referrals to the Reviewing Medical Director.
• Draft reduction and denial letters based on medical director reviews and applicable clinical guidelines.
• Maintain up-to-date knowledge of Medicare and Medicaid regulations and apply changes to departmental practices as needed.
• Collaborate with PA staff to ensure timely and efficient completion of departmental workflows.
• Contribute to the development and refinement of departmental programs, policies, and procedures.
• Lead or participate in special projects and initiatives as assigned.

Use your skills to make an impact

Required Qualifications

• Licensed as a Registered Nurse in the State of Wisconsin, including compact license.
• Two (2) or more years of experience in clinical care.
• Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook.
• At least 3-years experience with prior authorization/ utilization management.

Preferred Qualifications

• Bachelor of Science in Nursing
• Previous leadership experience
• Knowledge of Milliman (MCG) or InterQual.
• Knowledge of TruCare.
• Managed Care experience.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Monday through Friday, 8:30am – 5:00 pm Central Standard Time (CST)

WAH Internet Statement

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 recommended; 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.