Remote RN: Utilization & Pre-Authorization Specialist

Humana; United (LA); Remote; USD 71,000 - 98,000; Full time

Job summary

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent determinations within guidelines.

The role requires an active RN license, 2+ years of varied clinical nursing experience, and experience in utilization management; MS Office proficiency and strong independent work skills are essential.

Qualifications

• Active Licensed Registered Nurse (RN) in the state of Virginia or a compact-license state (eNLC) with no disciplinary action
• Minimum two years varied clinical nursing experience in acute care, skilled or rehabilitation settings
• Experience in utilization management, case management, discharge planning or home health/rehab
• Intermediate to advanced Microsoft Office skills and ability to troubleshoot 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 clinical information in medical management systems and follows established guidelines.

Skills

RN license

Clinical nursing experience

Utilization management

Microsoft Office proficiency

Independent worker

Tools

Microsoft Office

Systems navigation

Job description

Humana is seeking a Pre-Authorization Nurse to review requests for medical necessity and level of care, working remotely from Virginia or a compact-licensed state. You will educate providers, document clinical data, and make independent determinations within guidelines.

The role requires an active RN license, 2+ years of varied clinical nursing experience, and experience in utilization management; MS Office proficiency and strong independent work skills are essential.