Remote RN: Pre-Authorization & Utilization Review

Humana; Ohio; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana is seeking a Pre-Authorization Nurse to review and approve prior authorization requests, applying clinical judgment across care settings. The role involves education of providers, data entry in management systems, and adherence to guidelines in a remote environment.

Candidates should hold an active RN license in Virginia or a compact state, with 2+ years of acute or rehab nursing experience and familiarity with utilization management and discharge planning.

Qualifications

• Active RN license in Virginia or state in compact (eNLC) with no disciplinary action.
• Minimum two years varied clinical nursing experience in acute, skilled or rehab.
• Experience in utilization management, discharge planning or home health/rehab.
• Proficient in MS Office and using multiple systems remotely.

Responsibilities

• Educates providers on utilization and medical management processes.
• Enters and maintains clinical information in medical management systems.
• Makes decisions with minimal direction following guidelines/procedures.

Skills

RN license

Clinical nursing

Utilization management

Discharge planning

MS Office & systems

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Excel

PowerPoint

Job description

Humana is seeking a Pre-Authorization Nurse to review and approve prior authorization requests, applying clinical judgment across care settings. The role involves education of providers, data entry in management systems, and adherence to guidelines in a remote environment.

Candidates should hold an active RN license in Virginia or a compact state, with 2+ years of acute or rehab nursing experience and familiarity with utilization management and discharge planning.