Behavioral Health Prior Authorization Nurse

Humana; Wisconsin; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental, and vision

401(k) retirement savings plan

Paid time off

Disability benefits

Life insurance

Job summary

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid Market (iCare) team. This role involves reviewing the clinical appropriateness of prior authorization requests to ensure they meet medical necessity and other criteria.

The position is remote from WI, with a full-time schedule, Monday–Friday, 8:30am–5:00pm CST, and a comprehensive benefits package including medical, dental, vision, 401(k), PTO, disability and life insurance.

Qualifications

• Unrestricted RN license in Wisconsin or a compact state.
• 1 year of Utilization Management experience.
• 2 years of mental health and/or substance abuse rehabilitation experience.

Responsibilities

• Review authorization requests for inpatient behavioral health care.
• Provide complete and accurate documentation for approval or further review.
• Create reduction/denial letters based on review findings.
• Maintain understanding of Medicare and Medicaid guidelines.
• Collaborate with PA staff to ensure timely completion of workflows.

Skills

Utilization management

Mental health

Rehabilitation

Education

RN License Wisconsin/Compact

Job description

About This Role

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid Market (iCare) team. This role involves reviewing the clinical appropriateness of prior authorization requests to ensure they meet medical necessity and other criteria.

Highlights

• Pay: $71,100 - $97,800/year
• Location: Remote, WI
• Schedule: Full-time, Monday – Friday, 8:30am – 5:00pm CST
• Work Style: Home

What You'll Do

• Review authorization requests for inpatient behavioral health care.
• Provide complete and accurate documentation for approval or further review.
• Create reduction/denial letters based on the CMO/Medical Director's review.
• Maintain understanding of Medicare and Medicaid guidelines.
• Collaborate with PA staff to ensure timely completion of workflows.

Requirements

Education

• Unrestricted license as a Registered Nurse in the state of Wisconsin or compact state.

Experience

• One (1) year of experience in Utilization Management.
• Two (2) years of experience in mental health and/or substance abuse rehabilitation.

Licenses & Certifications

• Current RN License in Wisconsin or compact state required.

Benefits

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

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through their insurance services and healthcare services, they aim to help millions achieve their best health by delivering the care and service needed when required.