Job Details

Pre-Authorization Nurse 2 - Work at Home from PR ONLY

Company name
Humana Inc.

San Juan, PR, United States

Employment Type

Healthcare, Nursing, Bilingual, Case Management

Posted on
Nov 20, 2020

Apply for this job


Job Information


Pre-Authorization Nurse 2 - Work at Home from PR ONLY


San Juan

Puerto Rico


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. Educates providers on utilization and medical management processes. Enters and maintains 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. Follows established guidelines/procedures.

Required Qualifications

Registered Nurse from an accredited institution

Active RN license without restrictions in Puerto Rico

Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico)

Prior clinical experience in an acute care, skilled nursing, rehabilitation, OR discharge planning

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Health Plan experience

Previous Case Management Experience

Call center or triage experience

Previous experience managing Medicare members

Bilingual English/Spanish. Candidate selected will not be communicating in English with members.

Additional Information


Monday to Friday 8:30AM - 5:30PM, overtime


Work At Home from PR Only . Office is located at:

383 Ave FD Roosevelt | San Juan, PR, 00918-2131

Training: 6 months on site

ON CALL - Availability

Scheduled Weekly Hours


Company info

Humana Inc.
Website :

Similar Jobs:
Corporate Strategist
Location : San Juan, PR
Description Responsibilities Humana's Corporate Strategy team is a small, high-performing organization that works closely with Humana's senior leadership to chart the course for the company's future. Within Strategy Operations, ...
Informaticist 2
Location : San Juan, PR
Description The Informaticist 2 coordinates with other analytics, IT and business areas across the organization to ensure work is completed with insights from knowledge SMEs. The Informaticist 2 work assignments are varied and fr...
Description The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management...
The number of jobs listed on EmploymentCrossing is great. I appreciate the efforts that are taken to ensure the accuracy and validity of all jobs.
Richard S - Baltimore, MD
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
EmploymentCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
EmploymentCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2024 EmploymentCrossing - All rights reserved. 21 192