UM Nurse Pre-auth

Humana • Louisiana, MO

2d • 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. Educate providers on utilization and medical management processes. Enter and maintain pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follow established guidelines/procedures. Use your skills to make an impact

Requirements

• Multi State RN license
• A minimum of three (3) years varied nursing 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
• 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

Nice To Haves

• 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

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