RN/ LPN Prior Authorization Nurse - Remote FL

Profile

Description

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

Responsibilities

The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment along with MCG Criteria and state guidelines, 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

Required Qualifications

Active Unrestricted LPN/RN license in the state of Florida

3 years nursing experience in an Acute and/or Prior Authorization experience

Proficient with MS Office products including Word, Excel and Outlook

Ability to work independently under general instructions and with a team

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

Must be available to work Monday - Friday 8:00 AM - 5:00 PM EST and Holiday Rotation

Work At Home requirements

Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work.

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

Preferred Qualifications

Health Plan experience working with large carriers

Previous Medicaid experience a plus

Previous experience in Prior Authorization

Experience working with MCG guidelines

Ability to be licensed in multiple states without restrictions

Interview Process

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Modern Hire Text interview. CHECK JUNK/SPAM FOLDER In this interview, you review a set of interview questions over your phone and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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