Pre-Authorization Registered Nurse

Become a part of our caring community and help us put health first
 

Humana Healthy Horizons is seeking a Pre-Authorization Nurse 2 who will review prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder.

               

The Pre-Authorization Nurse 2 completes medical necessity 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 the 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 document procedures, regulations or professional standards with some interpretation.

Use your skills to make an impact
 

Required Qualifications

• Active Oklahoma or Compact Registered Nurse, RN, license without restrictions or disciplinary action.

• Minimum Two (2) years clinical nursing experience in acute care, emergency room, ICU, skilled or rehabilitation setting.

• Working 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.

Work Style: Remote Work at Home

Location: Oklahoma

Training Schedule: Must be able to attend training schedule. Monday - Friday; 8:00am - 5:00pm Central Time

Work Schedule:  The department has multiple schedules available:

• Monday through Friday 8:00 AM - 5:00 PM Central Time with rotating holiday and weekend rotations

• Saturday through Wednesday 8:00 AM – 5:00 PM Central Time with rotating holidays

• Friday through Tuesday 8:00 AM – 5:00 PM Central Time with rotating holidays

• Sunday through Thursday 8:00 AM – 5:00 PM Central Time with rotating holidays

Travel: Minimal travel for office meetings 1-2 times annually as business needs.

Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees 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 employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• 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 a plus (CCM).

• Experience working with MCG or Interqual guidelines.

• Triage experience a plus.

• Health Plan experience working with large carriers.

• Bilingual preferred.

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 correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  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 or computer 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.

SSN Alert Statement

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1; Paid time off, holidays, volunteer time and jury duty pay; Recognition pay; 401(k) retirement savings plan with employer match; Tuition assistance; Scholarships for eligible dependents; Parental and caregiver leave; Employee charity matching program; Network Resource Groups (NRGs)
Career development opportunities

#L1-Remote

Scheduled Weekly Hours

40

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.