Pre-Authorization Registered Nurse
Remote US, United States
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 often straightforward and of moderate complexity.
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. 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.
Use your skills to make an impact
Required Qualifications
Active enhance license compact, (eNLC), Registered Nurse, RN, without restrictions or disciplinary actions,
A minimum of three, (3) years varied 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.
Preferred Qualifications
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,
Working knowledge using the following systems/platforms CGX, MHK, Maccess, CAS.
Additional Requirements/Adherence
Workstyle: Remote work at home
Preferred Location: United States
Training Schedule: Must be able to attend training schedule. Monday - Friday; 8:00am - 5:00pm Eastern
Schedule:
Must be able to work a 40-hour work week, Monday through Friday, 8:00 AM to 5:00 PM Eastern Time and rotating weekends. and holidays. Leader will discuss during interview.
Over-time may be requested to meet business needs.
Travel: None
Work at Home Guidance
Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited).
Associates 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 associates with telephone equipment appropriate to meet the business …
This job isn't fresh anymore!
Search Fresh JobsJob Profile
California Dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Illinois Montana Remote US South Dakota Work from a dedicated space Work from a dedicated space lacking ongoing interruptions Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Work from Home in the state of California, Illinois, Montana, or South Dakota Workstyle
Benefits/Perks401k retirement 401k Retirement Savings Bonus Incentive Bonus incentive plan Career development Career development opportunities Caring community Competitive benefits Dental Disability Employee charity matching Employee charity matching program Flexible packages Health benefits Health benefits effective day 1 Health first Holidays Internet expense reimbursement Jury duty pay Life Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Recognition pay Remote work Scholarships Scholarships for eligible dependents Smart healthcare decisions Support whole-person well-being Telephone equipment provided Time off Tuition Assistance Variety of benefits Vision Vision Benefits Volunteer time Volunteer time off Work From Home
Tasks- Communication
- Educate providers
- Interpretation
- Planning
- Review prior authorization requests
- Training
- Utilization Management
Accessibility Authorization BI Business CAS Case Management CGX Clinical Clinical Judgment Communication Compensation Dental Discharge planning Education Excel Healthcare Healthcare services Health Plan Experience HIPAA Home Health Insurance InterQual IT Life Insurance Management MCG Medicaid Medical management Medical necessity Medicare MS Office Network Nursing Planning Policy PowerPoint Prior authorization Recruitment Registered Nurse Regulations Rehab Remote work RN Security Teams Technical Technology Training Travel Troubleshooting Utilization management Vision Wellness Windows Word
Experience3 years
EducationAssociate Associates Business Communication Education Healthcare Higher IT Management MS Nursing Registered Nurse RN
CertificationsCompact License Registered Nurse RN
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9