Pre-Authorization Nurse

About This Role The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies. This role is ideal for nurses who can make independent determinations and have strong clinical judgment. Highlights Pay : $71,100 - $97,800/year Location : Remote, LA Schedule : Mon-Fri, Tues-Sat, and Sun-Thurs for 8-hour shifts What You'll Do Review prior authorization requests for appropriate care and setting. Approve services or forward requests to the appropriate stakeholder. Complete medical necessity and level of care reviews using clinical judgment. Educate providers on utilization and medical management processes. Enter and maintain pertinent clinical information in various medical management systems. Make decisions regarding work methods with minimal direction. Follow established guidelines and procedures. Work independently under general instructions and with a team. Requirements Education Active RN license in the state of Louisiana Experience 2+ years of RN experience Preferred: Health Plan experience, Medicare/Medicaid experience, utilization management, case management, discharge planning, and/or home health or rehab experience Licenses & Certifications Active RN license in Louisiana required Ability to be licensed in multiple states without restrictions Benefits Medical, dental, and vision benefits 401(k) retirement savings plan Paid time off, including company and personal holidays Paid parental and caregiver leave Short-term and long-term disability Life insurance About Humana Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through their insurance services and CenterWell healthcare services, they make it easier for millions of people to achieve their best health, delivering the care and service needed when required. #J-18808-Ljbffr