Pre-Authorization Nurse

Humana

1d • $71,100 - $97,800 • Remote

About The Position

As a remote Pre-Authorization Nurse, you will coordinate care for MHS beneficiaries receiving care outside the MTF. You will monitor quality of care, identify, and document any potential quality issues regarding the patient's care. You will coordinate patient transfers and document in MSR. Review inpatient outlier cases, ensure appropriate discharge planning, and refer to Tier III care management as needed.

Requirements

• U.S. citizenship
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
• Registered Nurse with current in-state RN license
• At least 3 years of varied clinical RN nursing experience
• TRICARE experience
• Knowledge of MCG evidence-based criteria or comparable (such as Interqual, etc.)
• Self-provided internet service with 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

Nice To Haves

• Utilization Review/Quality Management experience
• BA/BSN degree

Responsibilities

• Coordinate care for MHS beneficiaries receiving care outside the MTF.
• Monitor quality of care.
• Identify and document any potential quality issues regarding the patient's care.
• Coordinate patient transfers and document in MSR.
• Review inpatient outlier cases.
• Ensure appropriate discharge planning.
• Refer to Tier III care management as needed.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level