Remote Utilization Review RN – Pre-Authorization

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

Benefits offered by this job

Remote work at home

Medical, dental, vision benefits

401(k) retirement savings

Job summary

Humana is seeking a Pre-Authorization Nurse to review and authorize services across care settings using clinical judgment and established guidelines. The role includes educating providers, entering clinical information into management systems, and coordinating with internal stakeholders.

The position is remote with optional travel to Humana offices. Requires an active RN license (VA or eNLC), 2+ years acute care experience, and experience in utilization management.

Qualifications

• Active RN license in VA or compact state (eNLC) with no disciplinary action.
• Minimum two years varied clinical nursing experience in acute care, skilled or rehab.
• Experience in utilization management, case management, discharge planning or home health.
• Proficient in Microsoft Word, Excel, PowerPoint; ability to navigate multiple systems and troubleshoot remotely.
• Ability to work independently with minimal direction.

Responsibilities

• Educates providers on utilization and medical management processes.
• Enters and maintains clinical information in management systems.
• Makes decisions with minimal direction; follows established guidelines.

Skills

RN license

Clinical nursing

Utilization management

Microsoft Office

Independent work

Job description

Humana is seeking a Pre-Authorization Nurse to review and authorize services across care settings using clinical judgment and established guidelines. The role includes educating providers, entering clinical information into management systems, and coordinating with internal stakeholders.

The position is remote with optional travel to Humana offices. Requires an active RN license (VA or eNLC), 2+ years acute care experience, and experience in utilization management.