Pre-Authorization Nurse 2 - Remote

Overview

The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder.

In Short

• Review prior authorization requests for appropriate care.
• Utilize clinical judgment for medical necessity and level of care reviews.
• Educate providers on utilization and medical management processes.
• Maintain clinical information in medical management systems.
• Work independently and collaboratively with minimal direction.
• Follow established guidelines and procedures.
• Make decisions regarding work methods in ambiguous situations.
• Possess an active RN license in required states.
• Engage in continuous improvement of consumer experiences.
• Occasional travel to Humana's offices for training or meetings.

Requirements

• Bachelor's degree.
• More than 3 years of technical nursing experience.
• Ability to be licensed in multiple states without restrictions.
• Proficient with MS Office products.
• Must be passionate about improving consumer experiences.
• Health Plan experience preferred.
• Previous Medicare/Medicaid experience is a plus.
• Experience in utilization management or case management.
• Familiarity with MCG or Interqual guidelines.

Benefits

• Health benefits effective day 1.
• Paid time off, holidays, and volunteer time.
• 401(k) retirement savings plan with employer match.
• Tuition assistance and scholarships for dependents.
• Parental and caregiver leave.
• Employee charity matching program.
• Career development opportunities.
• Recognition pay.
• Short-term and long-term disability insurance.
• Life insurance and many other benefits.