As a remote Pre-Authorization Nurse, you will report to a Supervisor of Pre-Authorization Nursing. You will coordinate care for MHS beneficiaries receiving care outside the MTF. You will monitor quality of care, identify, and document any potential quality issues regarding the patient's care. You will coordinate patient transfers and document in MSR. Review inpatient outlier cases, ensure appropriate discharge planning, and refer to Tier III care management as needed.
As a remote Pre-Authorization Nurse, you will report to a Supervisor of Pre-Authorization Nursing. You will coordinate care for MHS beneficiaries receiving care outside the MTF. You will monitor quality of care, identify, and document any potential quality issues regarding the patient's care. You will coordinate patient transfers and document in MSR. Review inpatient outlier cases, ensure appropriate discharge planning, and refer to Tier III care management as needed.
Required Qualifications- Our Department of Defense Contract requires U.S. citizenship for this position
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
- HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
- Registered Nurse with current in-state RN license
- At least 3 years of varied clinical RN nursing experience
- TRICARE experience
- Knowledge of MCG evidence-based criteria or comparable (such as Interqual, etc.)
Preferred Qualifications- Utilization Review/Quality Management experience
- BA/BSN degree
Work at Home RequirementsTo ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 06-12-2026
