Clinical Nurse

Winter Park, FL - USA

Monthly Salary: Not Disclosed

Posted on: 01-11-2025

Vacancies: 1 Vacancy

Job Summary

What were looking for: Humata Health Inc. is seeking a Clinical Nurse to join our team and work at the intersection of healthcare and AI 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.

This position also requires project management skills to coordinate policy digitization efforts track progress across multiple health plans and manage timelines and deliverables with cross-functional teams.

Location: Hybrid - Orlando Florida US or Remote US

Key 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.

Qualifications

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 Skills

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.

Why Join Humata Health

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

Pay Transparency

Humata Health will provide pay transparency information upon application to those in qualifying jurisdictions.

Our salary ranges are based on competitive pay for our companys size and industry. They are one part of the total compensation package that may also include equity variable compensation and benefits. Individual pay decisions are ultimately based on several factors including qualifications experience level skillset geography and balancing internal equity.

Humata Health is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion national origin age sex marital status ancestry neurotype physical or mental disability veteran status gender identity sexual orientation or any other category protected by law.

Join us in our mission to transform healthcare while building a life that works in harmony both in and outside the office.

What were looking for: Humata Health Inc. is seeking a Clinical Nurse to join our team and work at the intersection of healthcare and AI this role you will collaborate with clients composed of health plan utilization review nurses and internal teams to ensure that our AI systems accurately suppor...