Remote Utilization RN – Pre-Authorization

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

Benefits offered by this job

Bonus incentive plan

Remote work at home

Job summary

Humana is seeking a Pre-Authorization Nurse for remote work to review prior authorization requests and determine appropriate care following guidelines. The role involves clinical judgment, data entry in management systems, and collaboration with internal stakeholders.

A Virginia or compact-licensed RN with 2+ years of acute care experience is required, along with MS Office proficiency. Remote work at home with potential travel up to 5% for meetings; 40-hour workweek, 8:00 AM–5:00 PM ET;

Qualifications

• Active RN license in Virginia or a compact state (eNLC) with no disciplinary action.
• Minimum two years of varied clinical nursing experience in acute care, skilled, or rehabilitation settings.
• Experience in utilization management, case management, discharge planning, or home health/rehab.
• Proficient in Microsoft Office (Word, Excel, PowerPoint) and multi-system navigation; troubleshooting basic tech issues 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 guidelines.
• Makes independent decisions on work methods within established procedures.

Skills

RN license

Clinical nursing experience

Utilization management

Remote work capability

Independent work

Tools

Microsoft Office

Job description

Humana is seeking a Pre-Authorization Nurse for remote work to review prior authorization requests and determine appropriate care following guidelines. The role involves clinical judgment, data entry in management systems, and collaboration with internal stakeholders.

A Virginia or compact-licensed RN with 2+ years of acute care experience is required, along with MS Office proficiency. Remote work at home with potential travel up to 5% for meetings; 40-hour workweek, 8:00 AM–5:00 PM ET;