Pre-Authorization Registered Nurse

Humana; Town of Texas (WI); Remote; USD 40,000 - 80,000; Full time

Job summary

Join a forward-thinking organization dedicated to health and wellness as a Registered Nurse Intern. In this impactful role, you'll review prior authorization requests, utilizing your clinical judgment to ensure quality care. This internship offers a unique opportunity for transitioning military service members and spouses to gain valuable civilian experience while working remotely. Contribute to a mission-driven team that prioritizes health and well-being for diverse populations, including military personnel. Embrace this chance to grow professionally while making a difference in the community.

Qualifications

• Transitioning military service member or military spouse eligible for the internship.
• Active RN license in a participating state without restrictions.

Responsibilities

• Review prior authorization requests for appropriate care and setting.
• Educate providers on utilization and medical management processes.

Skills

Clinical nursing experience

Proficiency with MS Office

Ability to work independently

Ability to work as part of a team

Education

Active Compact RN license

Minimum of 2 years clinical nursing experience

Tools

MS Office (Word, Excel, PowerPoint, 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 approve services or forward requests to the appropriate stakeholder.

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

The Military Spouse Fellowship Program connects military spouses with employers offering various professional onsite, field, or remote opportunities.

The RN Intern will utilize Humana’s Medicaid training and apply previously acquired skills to perform medical necessity reviews for requested services, using clinical judgment and referring cases to internal stakeholders for review based on findings.

• Educates providers on utilization and medical management processes.
• Enters and maintains relevant clinical information in medical management systems.
• Works within established guidelines, regulations, and professional standards, with some interpretation.
• Employs various strategies to manage a member's physical, environmental, and psycho-social health issues.
• Identifies and resolves barriers to effective care.
• Follows established procedures and guidelines.
• Understands professional concepts, standards, regulations, and operating procedures in their work area.
• Makes decisions regarding work approach and priorities, following directions.

Use your skills to make an impact

Required Qualifications

• Transitioning Service Member eligible for SkillBridge or military spouse eligible for the fellowship.
• Active Compact RN license in a state participating in eNLC without restrictions or disciplinary actions.
• Minimum of 2 years clinical nursing experience in acute care, emergency room, ICU, skilled nursing, or rehabilitation settings.
• Proficiency with MS Office (Word, Excel, PowerPoint, Teams) and ability to quickly learn new systems and troubleshoot technical issues remotely.
• Ability to work independently and as part of a team.

Preferred Qualifications

• Interest in the managed care industry.
• Experience with Medicare/Medicaid, prior authorization, utilization management, or guidelines like MCG or Interqual.

Additional Requirements / Adherence

• Workstyle: Remote work at home.
• Location: Preference for residence in Humana Medicaid states: Louisiana, South Carolina, Wisconsin, Indiana, Oklahoma, Virginia, Florida, Kentucky, Texas, Ohio.
• Work Schedule: Weekdays, 8:00 AM to 5:00 PM Central Time.
• Travel: None required, but occasional travel to Humana offices may be necessary.

Work at Home Guidance

Home/Hybrid employees must have internet with minimum speeds of 25 Mbps download and 10 Mbps upload, using approved connection types. California, Illinois, Montana, and South Dakota residents will receive bi-weekly internet expense payments. A dedicated, interruption-free workspace is required to protect member PHI/HIPAA information.

Interview Process

Selected candidates will participate in HireVue virtual interviews via pre-recorded questions or SMS, lasting approximately 5-15 minutes. Please check your spam/junk folders for communication.

Ethics Notice

Louisiana ethics laws restrict current or former LDH Medicaid Division officials from applying within two years of separation. For details, visit the Louisiana Board of Ethics website.

While this is a remote position, occasional travel for training or meetings may be required.

Scheduled Weekly Hours: 40

About us

Humana Inc. is dedicated to putting health first for our teammates, customers, and community, providing services that improve quality of life for diverse populations including military personnel.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status. We are committed to affirmative action and equal opportunity employment practices.

About the company

Humana works to create personalized health paths that meet individual needs, promoting overall well-being.