Pre-Authorization RN - Remote LA

Profile

Job Information

Humana

Pre-Authorization RN - Remote LA

in

Metairie

Louisiana

Description

The Pre-Authorization Nurse 1 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 1 work assignments are often straightforward and of moderate complexity.

Responsibilities

Humana Benefits - How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

The Pre-Authorization Nurse 1 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.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

​Must Reside in the state of Louisiana

Required Qualifications

Active RN license in the state of Louisiana

Ability to be licensed in multiple states without restrictions

3 or more 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

Workstyle:

Remote work at home

Location: Must reside in Louisiana

Travel:

Must be willing to commute about 5-10% for annual meetings and any required onsite training as requested by the business.

Hours:

Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, weekend and over-time may be requested to meet business needs.

Training

: October 10th 2022

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Work-At-Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Health Plan experience working with large carriers

Compact nursing licensure

Previous Medicare/Medicaid experience a plus

Previous experience in utilization management, case management, discharge planning and/or home health or rehab

Certification in Case Management (CCM) or Managed Care Nursing (CMCN) a plus

Experience working with MCG or Interqual guidelines

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed)

If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#LI-KK1

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com