Pre-Authorization Nurse

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

📋 Description

• Evaluate prior authorization requests to ensure suitable care and appropriate setting.

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

• Conduct reviews of medical necessity and level of care utilizing clinical judgment.

• Refer cases to team members for further evaluation based on findings.

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

• Input and maintain clinical data within medical management systems.

• Understand department, segment, and organizational strategies and operational objectives.

• Make autonomous decisions concerning work methods while following established protocols.

• Occasionally visit Humana offices for training sessions or meetings.

⛳️ Requirements

• A minimum of 2 years of experience as a Registered Nurse (RN).

• Valid RN license in the state of Indiana.

• Capability to obtain licensure in multiple states without any restrictions.

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

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

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

• Minimum internet speed of 25 Mbps for downloads and 10 Mbps for uploads for remote work.

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

🏝️ Benefits

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

• Comprehensive medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance benefits.

• Requirement for a dedicated home workspace to support remote work.

• Self-managed internet service with a minimum of 25 Mbps download and 10 Mbps upload.