Pre-Authorization Nurse

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Evaluate prior authorization requests to ensure appropriate care and placement.

• Adhere to established guidelines and policies to approve services or escalate requests to the relevant stakeholders.

• Conduct medical necessity and level-of-care assessments using clinical expertise.

• Refer cases to internal stakeholders for further examination based on findings.

• Provide education to providers regarding utilization and medical management procedures.

• Input and maintain relevant clinical data in medical management systems.

• Interpret diverse assignments and independently identify suitable courses of action.

• Operate in alignment with departmental, segmental, and organizational strategies and objectives.

• Make decisions about work methods with minimal supervision.

• Comply with established guidelines and procedures.

⛳️ Requirements

• Minimum of 2 years of RN experience.

• Valid RN license in the state of Louisiana.

• Capability to obtain licensure in multiple states without restrictions.

• Availability to work Mon-Fri, Tues-Sat, or Sun-Thurs for 8-hour shifts.

• Proficient in MS Office applications including Word, Excel, and Outlook.

• Ability to work autonomously under general guidance and collaboratively within a team.

• Experience in Health Plans with large carriers is preferred.

• Previous experience with Medicare/Medicaid is preferred.

• Prior experience in utilization management, case management, discharge planning, and/or home health or rehabilitation is preferred.

• Familiarity with MCG or InterQual guidelines is preferred.

• Reliable internet service with a minimum of 25 Mbps download and 10 Mbps upload for remote or hybrid work.

• A dedicated workspace free from interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Occasional travel to Humana offices for training or meetings.