Pre-Authorization Nurse

Location: Remote Louisiana; active Louisiana RN license required. Work is scheduled from 8:00 AM to 5:00 PM Central Time, with regular weekend coverage possible.

Salary: $71,100–$97,800 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company providing services to Medicare, Medicaid, individual, family, military, and community members.

What you will do

• Review prior authorization requests for appropriate care settings using established guidelines and policies.
• Complete medical necessity and level-of-care reviews using clinical judgment.
• Approve services or refer cases to appropriate internal stakeholders for additional review.
• Educate providers on utilization and medical management processes.
• Enter and maintain clinical information in medical management systems.
• Make independent decisions in ambiguous situations while following established procedures.

Requirements

• At least 2 years of registered nursing experience.
• Active RN license in Louisiana and ability to obtain licenses in multiple states without restrictions.
• Availability for Monday–Friday, Tuesday–Saturday, or Sunday–Thursday eight-hour shifts, including weekend coverage.
• Proficiency with Microsoft Word, Excel, and Outlook.
• Ability to work independently under general instructions and collaborate with a team.
• Dedicated home workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds are required.

Nice to have

• Health plan experience with large carriers.
• Medicare or Medicaid experience.
• Experience in utilization management, case management, discharge planning, home health, or rehabilitation.
• Experience with MCG or InterQual guidelines.

Culture & Benefits

• Remote work with occasional travel to hirify.global offices for training or meetings.
• Medical, dental, and vision insurance.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and wellness benefits.