Pre-Authorization Nurse

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 the appropriate stakeholder • Complete medical necessity and level of care reviews for requested services using clinical judgment • Refer cases to team members for review depending on case findings • Educate providers on utilization and medical management processes • Enter and maintain relevant clinical information in various medical management systems • Understand department, segment, and organizational strategy and operating objectives • Make decisions regarding work methods in ambiguous situations with minimal direction • Occasionally travel to Humana offices for training or meetings

🎯 Requirements

• 2+ years of RN experience • Active RN license in the state of Indiana • Ability to be licensed in multiple states without restrictions • Previous experience in utilization management, case management, discharge planning and/or home health or rehab • Proficient with MS Office products including Word, Excel and Outlook • Ability to work independently under general instructions and with a team • Minimum internet speed of 25 Mbps download and 10 Mbps upload for work-from-home employees • Work from a dedicated space lacking 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 internet service for remote work • Dedicated workspace to protect member PHI / HIPAA information