Remote Pre-Authorization RN — Utilization Management

Humana; South Carolina; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, using clinical judgment to approve services or route to stakeholders. This remote role requires Virginia license or compact license, 2+ years acute care experience, and experience in utilization or case management.

Strong MS Office skills and comfort with multiple systems are essential. The position offers 40 hours per week, potential travel for training, and a competitive pay

Qualifications

• Active RN license in Virginia or compact state (eNLC) with no disciplinary action.
• Minimum two years varied clinical nursing experience in acute care, skilled or rehabilitation setting.
• Experience in utilization management, case management, discharge planning and/or home health or rehab.
• Proficient in Microsoft Office and able to troubleshoot across multiple systems in a remote environment.
• Ability to work independently under general instructions and with a team.

Responsibilities

• Educates providers on utilization and medical management processes.
• Enters and maintains pertinent clinical information in medical management systems.
• Makes decisions regarding own work methods following established guidelines.

Skills

RN license (state Virginia or compact)

Clinical nursing experience (2+ years)

Utilization/Case management experience

MS Office proficiency

Independent/ team collaboration

Job description

Humana is seeking a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, using clinical judgment to approve services or route to stakeholders. This remote role requires Virginia license or compact license, 2+ years acute care experience, and experience in utilization or case management.

Strong MS Office skills and comfort with multiple systems are essential. The position offers 40 hours per week, potential travel for training, and a competitive pay