Remote Behavioral Health Prior-Auth Nurse

Humana; United States; Hybrid; 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

Bonus incentive plan

Job summary

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid iCare team. You will review the clinical appropriateness of PA requests to ensure medical necessity and compliance with Medicare/Medicaid criteria.

This remote role requires strong documentation, collaboration with PA staff, and familiarity with guidelines. The position is 40 hours weekly CST, with occasional travel to Humana offices for trainings and collaboration.

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 rehab experience.
• Available to work 8:30am-5pm CST.
• Proficient with MS Office (Word, Excel, Outlook).

Responsibilities

• Review authorization requests for inpatient behavioral health care per Medicare/Medicaid criteria and Humana/iCare guidelines.
• Provide complete documentation supporting approval or forwarding for review by CMO/Medical Director.
• Create reduction/denial letters based on reviews and guidelines.
• Stay updated on Medicare/Medicaid guidelines and changes.
• Collaborate with PA staff to ensure timely workflow completion.

Skills

Utilization Management

Mental Health Experience

RN License

Tools

MS Office

Job description

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid iCare team. You will review the clinical appropriateness of PA requests to ensure medical necessity and compliance with Medicare/Medicaid criteria.

This remote role requires strong documentation, collaboration with PA staff, and familiarity with guidelines. The position is 40 hours weekly CST, with occasional travel to Humana offices for trainings and collaboration.