Remote Pre-Authorization Nurse | Utilization Management

Humana Inc; Town of Texas (WI); Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental, vision

401(k) retirement savings

Paid time off

Parental and caregiver leave

Short-term and long-term disability

Life insurance

Job summary

Humana Inc. is seeking a Pre-Authorization Nurse to review prior authorization requests, determine medical necessity, and educate providers on utilization processes in a remote, home-based setting.

The position requires 2+ years of RN experience, an active Indiana RN license (or multi-state licensure), and proficiency with MS Office. You will document clinical information and collaborate with care teams to ensure appropriate care decisions.

Qualifications

• 2+ years of RN experience.
• Active RN license in Indiana.
• Experience in utilization management, discharge planning, or home health.
• Proficient with MS Office (Word, Excel, Outlook).

Responsibilities

• Review prior authorization requests for appropriate care and setting.
• Approve services or forward requests to the appropriate stakeholder.
• Enter and maintain relevant clinical information in medical management systems.
• Educate providers on utilization and medical management processes.
• Work independently under general instructions with team support as needed.

Skills

RN experience

Active RN license

Utilization management

Independent work

MS Office

Team collaboration

Education

Bachelor's degree

Tools

Word

Excel

Outlook

Job description

Humana Inc. is seeking a Pre-Authorization Nurse to review prior authorization requests, determine medical necessity, and educate providers on utilization processes in a remote, home-based setting.

The position requires 2+ years of RN experience, an active Indiana RN license (or multi-state licensure), and proficiency with MS Office. You will document clinical information and collaborate with care teams to ensure appropriate care decisions.