Pre-Authorization Registered Nurse

🔥 0 minutes ago

🐊 Florida, Kentucky, +5 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌴 South Carolina – Remote ⚔️ Virginia – 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 the appropriate stakeholder • Complete medical necessity and level-of-care reviews for requested services using clinical judgment • Refer cases to internal stakeholders for review depending on findings • Educate providers on utilization and medical management processes • Enter and maintain pertinent clinical information in medical management systems • Interpret department, segment, and organizational strategy and operating objectives • Make decisions regarding work methods in occasionally ambiguous situations • Work with minimal direction and follow established guidelines and procedures

🎯 Requirements

• Active Licensed Registered Nurse (RN) in the state of Virginia or obtain a license in a state that participates in the compact license (eNLC) with no disciplinary action • Minimum two years of varied clinical nursing experience in an acute care, skilled or rehabilitation setting • Previous experience in utilization management, case management, discharge planning and/or home health or rehab • Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint • Ability to navigate multiple systems and platforms • Ability to troubleshoot and resolve basic technical difficulties in a remote environment • Ability to work independently under general instructions and with a team • Ability to work 8 hours Monday through Friday between 8:00 AM and 5:00 PM Eastern • May be required to work rotating holidays or weekends as determined by business needs • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Preferred: Health Plan experience working with large carriers • Preferred: Previous Medicare/Medicaid experience • Preferred: Certification in Case Management (CCM) or Managed Care Nursing (CMCN) • Preferred: Experience working with MCG or InterQual guidelines

🏖️ 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 • Wellness and smart healthcare decision support • Remote work at home • Occasional travel for training or meetings