Pre-Authorization Registered Nurse

IntelliResume; Virginia (MN); Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Parental and caregiver leave

Disability insurance

Life insurance

Job summary

Humana is seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings, and educate providers on utilization and management processes.

Requirements include an active RN license in VA or an eNLC-participating state, plus at least two years of varied clinical nursing experience in acute, skilled, or rehabilitation settings. Compensation aligns with market ranges.

Qualifications

• Active RN license in Virginia or compact-eligible state (eNLC).
• Minimum two years of varied clinical nursing experience in acute, skilled, or rehab settings.

Responsibilities

• Review prior authorization requests for appropriate care and setting.
• Approve services or forward requests to the appropriate stakeholder.
• Complete medical necessity and level of care reviews for requested services.
• Educate providers on utilization and medical management processes.
• Enter and maintain pertinent clinical information in medical management systems.
• Make decisions with minimal direction within established guidelines.
• Work independently and as part of a team.

Skills

Decision making

Independent worker

Provider education

Education

RN license (VA or eNLC)

Tools

Medical management systems

Job description

About This Role

The Pre-Authorization Registered Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies. This role is ideal for nurses with clinical experience who can work independently and make informed decisions.

Highlights

• Pay: $71,100 - $97,800/year
• Location: Remote, VA
• Residency: Must reside in Virginia or a state participating in the compact license (eNLC)
• Work Style: Remote work at home
• Schedule: Full-time, Monday through Friday, 8:00 AM to 5:00 PM Eastern

What You'll Do

• Review prior authorization requests for appropriate care and setting.
• Approve services or forward requests to the appropriate stakeholder.
• Complete medical necessity and level of care reviews for requested services.
• Educate providers on utilization and medical management processes.
• Enter and maintain pertinent clinical information in various medical management systems.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Work independently under general instructions and with a team.

Requirements

Education:

• Active Licensed Registered Nurse (RN) in the state of Virginia or obtain a license in a state that participates in the compact license (eNLC).

Experience:

• Minimum two (2) years varied clinical nursing experience in an acute care, skilled, or rehabilitation setting.
• Previous experience in utilization management, case management, discharge planning, and/or home health or rehab preferred.

Licenses & Certifications:

• Active RN license required.
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance and many other opportunities.

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through their Humana insurance services and CenterWell healthcare services, they make it easier for millions of people to achieve their best health by delivering the care and service they need, when they need it.