The Prior Authorization, Registered Nurse, RN, Intern will utilize Humana’s Medicaid training and engage formerly acquired skillsets to complete 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.
Work is managed and often guided by precedent and/or document procedures, regulations or professional standards with some interpretation.
Employs a variety of strategies, approaches and techniques to manage a member's physical, environmental, and psycho-social health issues.
Identifies and resolves barriers that hinder effective care.
Follows established guidelines/procedures.
Understands own work area professional concepts/standards, regulations, strategies, and operating standards.
Makes decisions regarding own work approach/priorities and follows direction.
Required Qualifications
Transitioning Service Member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship
Active Registered Nurse, RN, or Compact, (eNLC) license in the state of Oklahoma 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.
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
Preferred Qualifications
Possess an interest in working in the managed care industry
Previous Medicare/Medicaid experience a plus.
Previous experience in prior authorization, utilization management
Experience working with MCG or Interqual guidelines.
Additional Requirements / Adherence
Workstyle: Remote Work at Home
Location: Must Reside in Oklahoma
Work Schedule: Weekdays 8:00 AM to 4:30 PM Central Time
Travel: None
Work At Home Requirements
WAH 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
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
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 veteran status. 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.
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