Nurse Specialist - Authorization Review

Join Our Caring Community: Help Us Prioritize Health As a Nurse Specialist focused on Authorization Review, you will be instrumental in facilitating the care patients need by diligently reviewing prior authorization requests. Your role will involve adhering to established guidelines while leveraging your clinical expertise to make independent decisions that prioritize patient needs. In this engaging position, you will conduct detailed evaluations of medical necessity and levels of care for requested services. Your responsibilities will include escalating complex cases to internal stakeholders and providing essential guidance to healthcare providers about utilization and medical management processes. You will ensure accurate clinical information is maintained within our medical management systems, gaining a solid understanding of our strategic objectives that will empower you to make informed decisions with minimal oversight. Make a Difference with Your Expertise Qualifications We Are Looking For: Minimum of 2 years of experience in Utilization Management Active RN license in the states where you practice Capability to obtain licensure in additional states without restrictions At least three years of diverse nursing experience Preferred experience in utilization management, case management, discharge planning, or home health/rehab Proficient in MS Office applications including Word, Excel, and Outlook Able to work both independently and collaboratively within a team A genuine passion for enhancing consumer experiences in healthcare Preferred Additional Qualifications: Bachelor's degree Experience with major health insurance carriers Familiarity with Medicare/Medicaid processes is a plus Background in outpatient or home health Utilization Management Experience with MCG or Interqual guidelines Additional Information: Schedule: Monday through Friday, 8:00 AM - 5:00 PM, with flexibility for overtime or weekend work as necessary Work Location: Remote within the United States Travel Requirements: Less than 1% Internet Requirements for Remote Work: A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is required; a wired cable or DSL connection is preferred. Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense reimbursement. Humana will provide necessary telephone equipment. Work from a dedicated space to ensure the confidentiality of member PHI/HIPAA information. Hiring Process: We utilize an innovative interview technology called HireVue to streamline our hiring process, allowing us to connect with you at your convenience to discuss your relevant skills and experiences. Compensation: The salary range for this full-time role is $71,100 - $97,800 annually, based on experience and qualifications, with eligibility for a performance-based bonus incentive plan. Benefits: Humana offers comprehensive benefits that support your well-being and work-life balance, including medical, dental, and vision coverage, a 401(k) retirement plan, paid time off, and additional opportunities. Application Deadline: 01-19-2026 About Humana: Humana Inc. prioritizes health for our team members, customers, and communities. Our services focus on delivering accessible and effective healthcare to enhance lives throughout the communities we serve. Equal Opportunity Employer: Humana is committed to ensuring equal employment opportunities without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.

Created: 2026-03-04