Remote RN: Prior Authorization & Utilization Review

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

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.