Registered Nurse, Utilization Management - Remote

Overview

Humata Health Inc. is seeking a Clinical Nurse to join our team and work at the intersection of healthcare and AI technology. In this role, you will collaborate with clients composed of health plan utilization review nurses and internal teams to ensure that our AI systems accurately support medical necessity decisions and prior authorization reviews. A key part of the workflow involves digitizing medical policies so that AI can interpret and apply them consistently — but the larger mission is to leverage clinical expertise to make prior authorization faster, smarter, and more reliable.

In Short

• Partner with health plan utilization review nurses to validate and improve AI-driven prior authorization workflows.
• Review and structure medical policies to enable AI-powered automation of utilization review decisions.
• Apply clinical judgment to ensure that AI outputs align with evidence-based guidelines, payer standards, and medical coding practices.
• Participate in product review cycles by providing feedback on usability, accuracy, and workflow alignment.
• Guide product teams by translating clinical and utilization review needs into actionable product requirements.
• Collaborate with product and engineering teams to refine how clinical decision points are represented in AI models.
• Test, validate, and continuously improve AI-enabled review tools for accuracy and fairness.
• Provide feedback to enhance both policy digitization workflows and AI-driven decision support.
• Manage small-scale projects, including organizing digitization initiatives, tracking timelines, coordinating stakeholders, and reporting on progress.
• Stay current on payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.

Requirements

• Registered Nurse (RN) with an active license.
• 3+ years of experience in utilization management, prior authorization, case management, or related clinical roles.
• Strong understanding of payer policies, medical necessity criteria, and the prior authorization process.
• Working knowledge of medical coding systems (ICD-10, CPT, HCPCS).
• Comfort working with technology platforms; interest or experience in AI, clinical decision support, or health tech is a plus.
• Demonstrated project management skills — ability to organize complex workflows, manage deliverables, and ensure accountability across teams.
• Excellent critical thinking and problem-solving skills.
• Strong communication and collaboration abilities across clinical and technical teams.

Benefits

• Impactful Work: Contribute to innovative solutions that improve healthcare efficiency and patient outcomes.
• Remote Flexibility: Enjoy working remotely while being part of a collaborative team, with access to our new office in Winter Park, FL.
• Competitive Compensation: Enjoy competitive base compensation, equity through our Employee Stock Option Plan, and bonus-eligible roles.
• Comprehensive Benefits: Full benefits package including unlimited PTO and 401k program with employer match.
• Growth Opportunities: Advance your career in a fast-paced, high-impact environment with ample professional development.
• Inclusive Culture: Join a diverse workplace where your ideas and contributions are valued.