Pre-Authorization Nurse

IntelliResume; Kansas; Remote; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Paid parental and caregiver leave

Short-term and long-term disability

Life insurance

Job summary

Humana seeks a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, applying guidelines and policies. This role requires independent clinical judgment and strong decision-making abilities.

Remote position from LA with a choice of schedules (Mon-Fri, Tues-Sat, or Sun-Thurs), 8-hour shifts. Active RN license in Louisiana and 2+ years RN experience are required; health plan or utilization management background is a plus.

Qualifications

• Active RN license in Louisiana.
• 2+ years of RN experience.
• Experience in health plan, Medicare/Medicaid, utilization management, discharge planning, or home health is preferred.

Responsibilities

• Review prior authorization requests for appropriate care and setting.
• Approve services or forward requests to the appropriate stakeholder.
• Complete medical necessity and level of care reviews using clinical judgment.
• Educate providers on utilization and medical management processes.
• Enter and maintain pertinent clinical information in various medical management systems.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Work independently under general instructions and with a team.

Skills

Clinical judgment

Independent decision making

Utilization management

Medical reviews

Education

RN license (Louisiana)

Tools

Medical management systems

Job description

About This Role

The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies. This role is ideal for nurses who can make independent determinations and have strong clinical judgment.

Highlights

• Pay: $71,100 - $97,800/year
• Location: Remote, LA
• Schedule: Mon-Fri, Tues-Sat, and Sun-Thurs for 8-hour shifts

What You'll Do

• Review prior authorization requests for appropriate care and setting.
• Approve services or forward requests to the appropriate stakeholder.
• Complete medical necessity and level of care reviews using clinical judgment.
• Educate providers on utilization and medical management processes.
• Enter and maintain pertinent clinical information in various medical management systems.
• Make decisions regarding work methods with minimal direction.
• Follow established guidelines and procedures.
• Work independently under general instructions and with a team.

Requirements

Education

• Active RN license in the state of Louisiana

Experience

• 2+ years of RN experience
• Preferred: Health Plan experience, Medicare/Medicaid experience, utilization management, case management, discharge planning, and/or home health or rehab experience

Licenses & Certifications

• Active RN license in Louisiana required
• Ability to be licensed in multiple states without restrictions

Benefits

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

About Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through their insurance services and CenterWell healthcare services, they make it easier for millions of people to achieve their best health, delivering the care and service needed when required.