Pre-Authorization Nurse 2

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. 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. Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action.

As a Pre-Authorization Nurse 2, you will complete medical necessity and level of care reviews for requested services using clinical judgment, and refer to internal stakeholders for review depending on case findings. You will also educate providers on utilization and medical management processes and enter and maintain pertinent clinical information in various medical management systems. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding your own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed, while following established guidelines/procedures.

Use your skills to make an impact!

Requirements

• Bachelor's degree
• Less than 5 years of technical experience
• Active RN license in the state(s) in which the nurse is required to practice
• Ability to be licensed in multiple states without restrictions
• A minimum of three years varied nursing experience
• Proficient with MS Office products including Word, Excel and Outlook
• Ability to work independently under general instructions and with a team
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Health Plan experience working with large carriers
• Previous Medicare/Medicaid experience a plus
• Previous experience in utilization management, case management, discharge planning and/or home health or rehab
• Experience working with MCG or Interqual guidelines

Additional Information

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required.