Humata Health · 17 hours ago
RN, Clinical Nurse
United States
Full-time
Remote
Mid Level
3+ years expHumata 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 to ensure that our AI systems accurately support medical necessity decisions and prior authorization reviews, while also managing policy digitization efforts.
Artificial Intelligence (AI)Electronic Health Record (EHR)Health CareInformation Technology
Responsibilities
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
Qualification
Required
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
Preferred
Certification in medical coding (e.g., CPC, CCS, CCA, or equivalent)
Experience reviewing or implementing medical policies in a payer or managed care setting
Familiarity with health informatics, evidence-based guideline development, or digital clinical tools
Background in leading cross-functional projects or initiatives (formal project management certification is a plus)
Experience working with AI, automation tools, or clinical decision support systems
Ability to work in a fast-paced, innovative environment and contribute to process improvement
Benefits
Equity through our Employee Stock Option Plan
Bonus-eligible roles
Full benefits package including unlimited PTO and 401k program with employer match
Opportunities for professional development
Company
Humata Health
Humata Health is an AI-enabled deep clinical integration that creates prior authorizations for payers and providers using AI and automation.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$25M2024-06-20Series A· $25M
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