Pre-Authorization Nurse

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 prior authorization requests for appropriate care and setting • Follow guidelines and policies to approve services or forward requests to appropriate stakeholders • Complete medical necessity and level-of-care reviews using clinical judgment • Refer cases to internal stakeholders for review based on findings • Educate providers on utilization and medical management processes • Enter and maintain pertinent clinical information in medical management systems • Interpret varied assignments and independently determine appropriate courses of action • Work according to department, segment, and organizational strategy and operating objectives • Make decisions regarding work methods with minimal direction • Follow established guidelines and procedures

🎯 Requirements

• 2+ years of RN experience • Active RN license in the state of Louisiana • Ability to be licensed in multiple states without restrictions • Must be able to work Mon-Fri, Tues-Sat, or Sun-Thurs roles for 8-hour shifts • Proficient with MS Office products including Word, Excel, and Outlook • Ability to work independently under general instructions and with a team • Health Plan experience working with large carriers (preferred) • Previous Medicare/Medicaid experience (preferred) • Previous experience in utilization management, case management, discharge planning and/or home health or rehab (preferred) • Experience working with MCG or InterQual guidelines (preferred) • Internet service with at least 25 Mbps download and 10 Mbps upload for home or hybrid home/office work • Dedicated workspace 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 • Occasional travel to Humana offices for training or meetings