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

Are you a transitioning military service member or a Military Spouse looking for an internship that supports the goal to put health first?
The Prior Authorization, Registered Nurse, RN, Intern will review prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder.

The DOD SkillBridge Internship Program provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.

The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities.

               

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.

Use your skills to make an impact
 

Required Qualifications

• Transitioning Service Member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship

• Active Compact Registered Nurse license in a state that participates in the enhanced, (eNLC) licensure 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: Prefer residence in Humana Medicaid State Locations: Louisiana, South Carolina, Wisconsin, Indiana, Oklahoma, Virginia, Florida, or Kentucky, Texas, Ohio

• Work Schedule:  Weekdays 8:00 AM to 5:00 PM Central Time

• Travel: None

Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested, Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

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