Remote Pre-Authorization & Utilization Nurse

NurseRemotely; United States; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Pre-Authorization Nurse 2 to review requests for medical necessity and level of care, using clinical judgment and guidelines. The role supports education of providers and data entry in clinical systems, with opportunities to work remotely and occasional travel for trainings.

A strong RN background, Indiana licensure, and multitier licensure readiness are required. Applicants should have familiarity with utilization management or case management, plus MS Office proficiency and

Qualifications

• 2+ years of RN experience.
• Active RN license in the state of Indiana.
• Ability to be licensed in multiple states without restrictions.
• Experience in utilization management or case management preferred.
• Proficient with Word, Excel and Outlook.
• Able to work independently and with a team.

Responsibilities

• Review prior authorization requests for medical necessity and level of care.
• Educate providers on utilization and medical management processes.
• Enter and maintain clinical information in medical management systems.
• Interpret guidelines and follow organizational procedures.
• Make independent decisions with minimal direction when needed.
• Travel to Humana offices for training or meetings as required.

Skills

RN experience

Indiana RN license

Multistate licensure

Utilization management

MS Office proficiency

Independent working

Education

Bachelor's degree

Tools

MS Office

Job description

Humana is seeking a Pre-Authorization Nurse 2 to review requests for medical necessity and level of care, using clinical judgment and guidelines. The role supports education of providers and data entry in clinical systems, with opportunities to work remotely and occasional travel for trainings.

A strong RN background, Indiana licensure, and multitier licensure readiness are required. Applicants should have familiarity with utilization management or case management, plus MS Office proficiency and