Remote Behavioral Health Prior Authorization Nurse

Humana Inc; Northern (KY); Hybrid; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Job summary

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

The role requires an RN license in Wisconsin or a compact state, 1 year of utilization management experience, and 2 years in mental health/substance use rehabilitation. Typical hours are 8:30am–5:00pm CST with remote work and occasional office meetings.

Qualifications

• Unrestricted RN license in Wisconsin or a compact state.
• 1 year of Utilization Management experience.
• 2 years of mental health and/or substance use rehabilitation experience.
• Available to work 8:30am–5:00pm CST.

Responsibilities

• Review authorization requests for inpatient behavioral health care according to Medicare/Medicaid criteria, Humana/iCare guidelines, and PA policies.
• Provide complete documentation with rationale for approval, or forwarding to the CMO/Medical Director for further review.
• Create reduction/denial letters based on the CMO/Medical Director's review and guidelines.
• Maintain understanding of Medicare/Medicaid guidelines and stay updated.
• Collaborate with PA staff to ensure timely workflows.

Skills

Utilization Management

Mental Health

Regulatory Knowledge

MS Office

Job description

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

The role requires an RN license in Wisconsin or a compact state, 1 year of utilization management experience, and 2 years in mental health/substance use rehabilitation. Typical hours are 8:30am–5:00pm CST with remote work and occasional office meetings.