Job Description

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

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 often straightforward and of moderate complexity.

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 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.

Use your skills to make an impact
 

Required Qualifications

• Active RN license in the state of Louisiana

• Ability to be licensed in multiple states without restrictions

• 3 or more years varied nursing experience

• Proficient with MS Office products including Word, Excel and Outlook

• Ability to work independently under general instructions and with a team 

Preferred Qualifications

• Health Plan experience working with large carriers

• Compact nursing licensure

• 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 (CCM) or Managed Care Nursing (CMCN) a plus

• Experience working with MCG or Interqual guidelines

Additional Information

Workstyle: Remote work at home

Location: Must reside in Louisiana

Travel: Must be willing to commute about 5-10% for annual meetings and any required onsite training as requested by the business.

Hours: Must be able to work a 40-hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, - May be required to work rotating holidays or weekends as determined by business needs

Work-At-Home Requirements

·       Must have the ability to provide a high-speed wireless, DSL or cable modem (including VPN tunnel) 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 Internet service is NOT allowed for this role.

·       A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Scheduled Weekly Hours

40

Pay 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.

 

$69,800 - $96,200 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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 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.