Remote RN: Utilization & Pre-Authorization Specialist

Humana; Oklahoma; Teletrabalho; USD 71 000 - 98 000; Tempo integral

Resumo da oferta

Humana is seeking a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, using clinical judgment to approve or refer as needed.

The role emphasizes education of providers, documentation in medical management systems, and independent decision-making within established guidelines. Remote work options and standard 40-hour weeks are provided, with occasional travel for meetings as required.

Qualificações

• Active RN license in VA or a compact state (eNLC) with no disciplinary action.
• Minimum two years’ varied clinical nursing experience in acute, skilled, or rehabilitation settings.
• Experience in utilization management, discharge planning, or home health or rehab.

Responsabilidades

• Educates providers on utilization and medical management processes.
• Enters and maintains clinical information in management systems and aligns with strategy.
• Makes decisions about own work methods with minimal direction and follows guidelines.

Conhecimentos

RN license (VA or compact eNLC)

2+ years clinical nursing experience

Independent work capability

Remote work capability

Ferramentas

Microsoft Word

Excel

PowerPoint

Descrição da oferta de emprego

Humana is seeking a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, using clinical judgment to approve or refer as needed.

The role emphasizes education of providers, documentation in medical management systems, and independent decision-making within established guidelines. Remote work options and standard 40-hour weeks are provided, with occasional travel for meetings as required.