Pre-Authorization Registered Nurse

Humana; Fort Myers (FL); Remote; USD 45,000 - 70,000; Full time

Job summary

Join an innovative organization dedicated to prioritizing health and wellness. This internship offers military service members and spouses a unique opportunity to gain valuable experience in a supportive environment. As a Registered Nurse Intern, you will play a crucial role in reviewing prior authorization requests and ensuring quality care for our members. You will utilize your clinical judgment and skills while working remotely, making a significant impact on the lives of those we serve. If you're passionate about healthcare and eager to make a difference, this role is perfect for you.

Benefits

Remote Work

Flexible Schedule

Professional Development Opportunities

Health Insurance

Paid Time Off

Qualifications

• Transitioning military service members or spouses eligible for internship.
• Active RN license required without restrictions.
• Two years of clinical nursing experience in acute care settings.

Responsibilities

• Review prior authorization requests and engage in medical necessity reviews.
• Educate providers on utilization and medical management processes.
• Identify and resolve barriers to effective care.

Skills

Clinical Nursing Experience

MS Office Suite

Utilization Management

Communication Skills

Education

Active Compact Registered Nurse License

Two Years Clinical Experience

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Teams

Job description

Become a part of our caring community and help us put health first
Are you a transitioning military service member or a Military Spouse looking for an internship that supports the goal to put health first?
The Prior Authorization, Registered Nurse, RN, Intern will review prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder.

The DOD SkillBridge Internship Program provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.

The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities.

The Prior Authorization, Registered Nurse, RN, Intern will utilize Humana’s Medicaid training and engage formerly acquired skillsets to complete medical necessity reviews for requested services using clinical judgment and 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 the medical management systems.

• Work is managed and often guided by precedent and/or document procedures, regulations or professional standards with some interpretation.

• Employs a variety of strategies, approaches and techniques to manage a member's physical, environmental, and psycho-social health issues.

• Identifies and resolves barriers that hinder effective care.

• Follows established guidelines/procedures.

• Understands own work area professional concepts/standards, regulations, strategies, and operating standards.

• Makes decisions regarding own work approach/priorities and follows direction.

Use your skills to make an impact

Required Qualifications

• Transitioning Service Member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship

• Active Compact Registered Nurse license in a state that participates in the enhanced, (eNLC) licensure without restrictions or disciplinary action.

• Minimum Two (2) years clinical nursing experience in acute care, emergency room, ICU, skilled or rehabilitation setting.

• Working knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment.

• Ability to work independently under general instructions and with a team.

• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook

Preferred Qualifications

• Possess an interest in working in the managed care industry

• Previous Medicare/Medicaid experience a plus.

• Previous experience in prior authorization, utilization management

• Experience working with MCG or Interqual guidelines.

Additional Requirements / Adherence

• Workstyle: Remote Work at Home

• Location: Prefer residence in Humana Medicaid State Locations: Louisiana, South Carolina, Wisconsin, Indiana, Oklahoma, Virginia, Florida, or Kentucky, Texas, Ohio

• Work Schedule: Weekdays 8:00 AM to 5:00 PM Central Time

• Travel: None

Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested, Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.(please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Ethics Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.