Job Description

Become a part of our caring community. The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The role includes completing medical necessity and level of care reviews for requested services using clinical judgment and referring to internal stakeholders for review depending on case findings. Responsibilities Send and receive telephonic calls averaging 50% communication with providers. Educate providers on utilization and medical management processes. Enter and maintain pertinent clinical information in various medical management systems. Understand own work area professional concepts/standards, regulations, strategies and operating standards. Make decisions regarding own work approach/priorities and follow direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact. Required Qualifications Must reside in Oklahoma. Registered Nurse with a compact nursing license. 3+ years of clinical nursing experience. Intermediate to advanced knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows environment, and ability to quickly learn new systems and troubleshoot basic technical difficulties in a remote environment. Ability to work independently under general instructions and with a team. Preferred Qualifications Health plan experience working with large carriers. Previous Medicare/Medicaid experience. Previous experience in pre-authorization, utilization management, case management, discharge planning, and/or home health or rehab. Experience working with MCG or Interqual guidelines. Additional Information Self-provided internet service must meet minimum criteria: download speed of 25Mbps, upload speed of 10Mbps. Wireless, wired cable, or DSL connection is suggested; satellite, cellular, and microwave connection allowed only if approved by leadership. Employees working from home in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expense. Humana will provide telephone equipment appropriate to meet business requirements. Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information. Travel While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours 40 hours per week. Pay Range $71,100 – $97,800 per year. The compensation range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. This job is eligible for a bonus incentive plan. Benefits Paid time off, holidays, volunteer time and jury duty pay. Recognition pay. 401(k) retirement savings plan with employer match. Tuition assistance and scholarships for eligible dependents. Parental and caregiver leave. Employee charity matching program. Network Resource Groups (NRGs). Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. It also is the policy of Humana to take affirmative action, in compliance with Section503 of the Rehabilitation Act and VEVRAA, to employ and advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. #J-18808-Ljbffr

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