RN, Utilization & Prior Authorization (Remote)

Humana Inc; Louisiana (MO); Hybrid; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. seeks a Pre-Authorization Nurse to review prior authorization requests, determine appropriate care, and educate providers on utilization management.

The role requires independent clinical judgment, system data entry, and adherence to guidelines to support Humana's Care Management objectives. The candidate should have 2+ years of RN experience, an active Louisiana RN license (or ability to obtain multi-state licensure), and proficiency in MS Office.

Qualifications

• 2+ years of RN experience.
• Active RN license in the state of Louisiana.
• Ability to be licensed in multiple states without restrictions.
• Must be able to work: Mon-Fri, Tues-Sat. and Sun- Thurs roles for 8 hour shifts.
• Proficient with MS Office products including Word, Excel and Outlook.
• Ability to work independently under general instructions and with a team.

Responsibilities

• Review prior authorization requests for appropriate care and setting, using guidelines and policies.
• Approve services or forward requests to the appropriate stakeholder.
• Complete medical necessity and level of care reviews using clinical judgment.
• Educate providers on utilization and medical management processes.
• Enter and maintain pertinent clinical information in medical management systems.

Skills

RN experience

Louisiana license

Multi-state licensure

MS Office

Flexible schedule

Job description

Humana Inc. seeks a Pre-Authorization Nurse to review prior authorization requests, determine appropriate care, and educate providers on utilization management.

The role requires independent clinical judgment, system data entry, and adherence to guidelines to support Humana's Care Management objectives. The candidate should have 2+ years of RN experience, an active Louisiana RN license (or ability to obtain multi-state licensure), and proficiency in MS Office.