Remote Utilization Nurse — Pre-Authorization & Care Review

Humana; Virginia; 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 and authorize care requests in a remote role based in Virginia or a compact-license state. You will evaluate medical necessity, coordinate with internal stakeholders, and educate providers on utilization processes.

The position requires an active Virginia RN license (or eNLC-compatible state), 2+ years of acute care experience, and proficiency with MS Office and multiple systems.

Qualifications

• RN license in Virginia or in a compact state (eNLC) with no disciplinary action
• Minimum two years varied clinical nursing experience in acute care, skilled or rehab settings
• Experience in utilization management, case management, discharge planning and/or home health or rehab

Responsibilities

• Educates providers on utilization and medical management processes.
• Enters and maintains clinical information in medical management systems across multiple platforms.
• Makes decisions about work methods with minimal direction following established guidelines.

Skills

MS Office

Independent work

System navigation

Tools

MCG guidelines

Interqual guidelines

Job description

Humana is seeking a Pre-Authorization Nurse to review and authorize care requests in a remote role based in Virginia or a compact-license state. You will evaluate medical necessity, coordinate with internal stakeholders, and educate providers on utilization processes.

The position requires an active Virginia RN license (or eNLC-compatible state), 2+ years of acute care experience, and proficiency with MS Office and multiple systems.