Remote Humana Rn Jobs in Austin, TX (NOW HIRING)

Registered Nurse, Utilization Review (Remote)

Local Candidates in the Austin, TX Area Only

Long Term Opportunity | High Potential for Extension

Use Your Clinical Expertise to Improve Healthcare Outcomes, Without Providing Direct Patient Care

Are you an experienced Registered Nurse looking to transition away from bedside care while continuing to make a meaningful impact on patients' healthcare journeys? If you have a strong clinical background and experience evaluating medical necessity, this is an excellent opportunity to utilize your nursing expertise in a remote, collaborative environment.

Join a team dedicated to ensuring members receive medically appropriate, high quality, and cost-effective healthcare services while working alongside physicians, healthcare providers, and interdisciplinary teams.

Why You'll Love This Opportunity

• Remote position for candidates living in the Austin, Texas area
• No direct patient care
• Long term contract with a high likelihood of extension
• Monday through Friday schedule with occasional approved overtime
• Opportunity to use your clinical knowledge to improve healthcare quality and outcomes
• Collaborative and supportive team environment
• Work with leading healthcare professionals and providers across Texas

Schedule

• Must be available to work any 8-hour shift between 7:00 AM and 7:00 PM
• Required shift availability includes 10:00 AM to 7:00 PM
• Occasional overtime may be required and approved based on business needs

What You'll Do

As a Utilization Review Registered Nurse, you will use your clinical judgment to evaluate medical services and ensure members receive appropriate, medically necessary care.

Your responsibilities will include:

• Conduct pre-service, concurrent, and retrospective utilization reviews
• Evaluate medical necessity for outpatient services and out-of-network care
• Assess the appropriateness of treatment settings using evidence based clinical guidelines
• Collaborate with physicians, healthcare providers, and interdisciplinary teams
• Promote high-quality, cost-effective healthcare outcomes
• Optimize member benefits while ensuring compliance with Medicaid requirements
• Apply Texas Administrative Code (TAC) guidelines and medical necessity criteria
• Document review decisions accurately and thoroughly
• Maintain productivity, quality, and compliance standards
• Participate in team meetings, training, and continuous improvement initiatives

Qualifications

We're looking for professionals who have:

• Current Registered Nurse (RN) license in good standing
• Experience performing Utilization Review, Case Management, Care Management, or Medical Necessity reviews
• Knowledge of Medicaid programs and utilization management principles
• Experience applying medical necessity criteria
• Understanding of the Texas Administrative Code (TAC)
• Strong clinical assessment and critical thinking skills
• Excellent written and verbal communication abilities
• Strong organizational and time management skills
• Ability to work independently in a remote environment

Technical Skills

• Microsoft Word
• Microsoft Excel
• Electronic documentation systems
• Ability to navigate multiple computer applications simultaneously

Ideal Candidate

You'll thrive in this role if you:

• Enjoy using clinical expertise to improve healthcare outcomes
• Have exceptional analytical and critical thinking skills
• Are detail oriented and able to make sound clinical decisions
• Communicate professionally with providers and interdisciplinary teams
• Can manage multiple priorities in a fast-paced environment
• Work independently while remaining engaged with a collaborative remote team

Apply Today!

If you're ready to leverage your nursing experience in a rewarding remote role that supports quality healthcare delivery, we'd love to hear from you.

This is an outstanding opportunity for an experienced Registered Nurse seeking a professional, non-bedside position with long term potential and meaningful impact!

Throughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.
We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.
MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.
We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at www.mmcgrp.com
Benefits with MMC Group
MMC offers health insurance plans for our active candidates on assignment, including:

• Medical, dental, and vision coverage
• Life and disability insurance
• Additional voluntary benefits

Join MMC and enjoy the support of a team that values your well-being, both on and off the job!
MMC strives to ensure all job postings confirm details of the position, the rate of pay, and acknowledge that medical benefits are offered.
Get started on your career journey today! Apply to become a part of the MMC Team!
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.