Pre-Authorization Nurse

Become a part of our caring community 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. Use your skills to make an impact

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 Requirements To 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 Hours 40 Pay Range The 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 Benefits Humana, 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 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Apply To This Job