Pre-Authorization Nurse

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 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

• Coordinate care for MHS beneficiaries receiving care outside the MTF • Monitor quality of care • Identify and document potential quality issues regarding patient care • Coordinate patient transfers • Document in MSR • Review inpatient outlier cases • Ensure appropriate discharge planning • Refer cases to Tier III care management as needed • Report to a Supervisor of Pre-Authorization Nursing

🎯 Requirements

• U.S. citizenship required • Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service) • Candidates currently living in Puerto Rico cannot be hired for this position • Registered Nurse with current in-state RN license • At least 3 years of varied clinical RN nursing experience • TRICARE experience • Knowledge of MCG evidence-based criteria or comparable criteria such as InterQual • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on 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 • Self-provided home internet service requirements/support for remote work • Remote work arrangement • Occasional travel to Humana offices for training or meetings