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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. 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.
Job Responsibility:
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
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
Nice to have:
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
Interest or experience in AI, clinical decision support, or health tech is a plus