Remote Pre-Authorization Nurse

About the role

As a Remote Pre‑Authorization Nurse you will support Military Health System (MHS) beneficiaries receiving care outside the Military Treatment Facility. Reporting to the Supervisor of Pre‑Authorization Nursing, you will ensure quality of care, coordinate transfers and assist with discharge planning.

Key responsibilities

• Coordinate care for MHS beneficiaries receiving care outside the MTF.
• Monitor and document quality of care and identify potential issues.
• Coordinate patient transfers and record actions in the Medical Service Record (MSR).
• Review inpatient outlier cases and ensure appropriate discharge planning.
• Refer cases to Tier III care management when needed.

Required profile

• Registered Nurse with a current in‑state RN license.
• Minimum three years of varied clinical RN experience.
• Experience with TRICARE and familiarity with MHS processes.
• U.S. citizenship and ability to obtain interim government security clearance.
• Residency outside Puerto Rico.

Required skills

• Knowledge of MCG evidence‑based criteria or comparable systems such as Interqual.
• Utilization Review experience.
• Quality Management experience.
• Familiarity with TRICARE processes.

What we offer

• Fully remote work with a dedicated home workspace.
• Bi‑weekly internet stipend for eligible states (CA, IL, MT, SD).
• Telephone equipment provided by Humana.
• Occasional travel to Humana offices for training or meetings.
• Full‑time schedule of 40 hours per week.