[Hiring] Pre-Authorization Nurse @Humana

Role Description

The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder. The Pre-Authorization Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Completes medical necessity and level of care reviews for requested services using clinical judgment.
• Refers to internal stakeholders for review depending on case findings.
• Educates providers on utilization and medical management processes.
• Enters and maintains pertinent clinical information in various medical management systems.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Qualifications

• 2+ years of RN experience
• Active RN license in the state of Louisiana
• Ability to be licensed in multiple states without restrictions
• Proficient with MS Office products including Word, Excel, and Outlook
• Ability to work independently under general instructions and with a team

Requirements

• Must be able to work Mon-Fri, Tues-Sat, and Sun-Thurs roles for 8-hour shifts.

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Additional Information

• Work Schedule: This position operates on an 8:00 AM to 5:00 PM Central Time (CT) schedule.
• Regular workdays are not limited to Monday through Friday and include weekend coverage.
• Scheduled Weekly Hours: 40
• Pay Range: $71,100 - $97,800 per year
• This job is eligible for a bonus incentive plan based upon company and/or individual performance.
• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required; a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.