Pre-Authorization Nurse

Humana • Oklahoma City, OK

4d • Remote

About The Position

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 forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings.

Requirements

• Must Reside in Oklahoma
• Registered Nurse, licensed in Oklahoma without restrictions
• 3+ years of clinical nursing experience
• Intermediate to Advanced knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment
• Ability to work independently under general instructions and with a team

Nice To Haves

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

Responsibilities

• Sending and receiving telephonic calls averaging 50% communication with providers
• Educates providers on utilization and medical management processes
• Enters and maintains pertinent clinical information in various medical management systems
• Understands own work area professional concepts/standards, regulations, strategies and operating standards
• Makes decisions regarding own work approach/priorities and follows direction.
• Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and 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 and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees