RN Prior-Authorization - Medicaid - Louisville Kentucky

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 for Humana's Kentucky Medicaid Plan. The Pre-Authorization Nurse work assignments are often straightforward and of moderate complexity.

Responsibilities

Where you Come In

The Pre-Authorization Nurse 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.

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed


Minimum of an Associates Degree
Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction.
Minimum of 3 years' experience as a nurse in a clinical setting
Strong Proficiency with MS Office Suite Word, Excel, Power Point and ability to learn multiple systems
Experience with the development and implementation of policies and procedures
Ability to follow direction, thrive in a change environment, and wiliness to learn daily


Additional Requirements:

Hours: Typically an 8 hour shift Monday-Friday either 8:00 - 5:00 or 9:00 - 6:00 with rotating on-call coverage and oversight during weekends and holidays.

This role may require limited travel, (less than 10%) to support business needs.

Will need to be able to travel to the Louisville office based on business needs.

Preferred Qualifications


Bachelor's Degree
Claims, authorization experience
MCG experience
Care Management experience in an acute care, skilled or Rehabilitation clinical setting
Certified Case Manager, CCM
Health Plan experience
Medicaid experience
Call center or triage experience
Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.


Additional Information - How we Value You


Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M


Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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 an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

Sign Up Now - WashingtondcCrossing.com