Behavioral Health Prior Authorization Nurse

🔥 14 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review authorization requests for inpatient behavioral health care pursuant to applicable Medicare and Medicaid criteria, Humana/iCare guidelines, and PA Department policies and procedures • Provide complete and accurate documentation specifying rationale for approval or forwarding to the CMO/Medical Director for further review • Create reduction/denial letters based on the CMO/Medical Director's review and applicable guidelines • Maintain a thorough understanding of Medicare and Medicaid guidelines and stay abreast of updates and changes • Collaborate with PA staff to ensure timely completion of all workflows within the Department

🎯 Requirements

• Unrestricted license as a Registered Nurse in the state of Wisconsin or compact state • One (1) year of experience in Utilization Management • Two (2) years of experience in mental health and/or substance abuse rehabilitation • Available to work 8:30am-5pm in Central Standard Time (CST) • Proficient with MS Office products including Word, Excel and Outlook • Previous experience in case management, discharge planning and/or home health or rehab (preferred) • Experience working with MCG or InterQual guidelines (preferred) • Health Plan experience working with large carriers (preferred) • Previous Medicare/Medicaid experience (preferred) • Minimum download speed of 25 Mbps and upload speed of 10 Mbps • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Work-from-home arrangement • Training and meeting opportunities