Remote RN: Prior Authorization & Utilization Review

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

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.