Pre-Authorization Nurse

Humana • Jackson, MS • 3h ago

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.

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

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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Hospital & Medical

Summary Position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific eligibility requirements per VHA policy and submit your EDRP application...

2d ago

Go to Apply

Inpatient Medical Coding Auditor

Humana • Jackson, MS • 2d ago

Hospital & Medical

Become a part of our caring community Are you a detail-driven coding expert who enjoys solving complex clinical puzzles and making a measurable impact on payment accuracy and provider satisfaction? Humana, a Fortune 100...

2d ago

Go to Apply

Licensed Practical or Vocational Nurse- Specialty Clinics

Veterans Affairs, Veterans Health Administration • Jackson, MS • 3d ago

Hospital & Medical

Summary The Licensed Practical Nurse (LPN) - Specialty Clinics will provide safe, routine care to Veterans at the G.V. (Sonny) Montgomery VA Medical Center in Jackson, MS; within both inpatient and outpatient units. The...

3d ago

Go to Apply

VP, Physician Review and Market Insights

Humana • Jackson, MS • 3d ago

Hospital & Medical

Become a part of our caring community Provides executive leadership to Humana. The Chief Medical Officer, Utilization Management (UM) will serve as the clinical strategist, operator, and visionary for Humana's Utilizatio...

3d ago

Go to Apply

Maintenance Tech - Industrial Manufacturing Electrical/Mechanical

Packing Corp of America • Pearl, MS • 3d ago

Hospital & Medical

3d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)