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

Humana Healthy Horizons is seeking a Pre-Authorization Nurse 2 who 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 Pre-Authorization Nurse 2 completes 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.

• 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 document procedures, regulations or professional standards with some interpretation.

Use your skills to make an impact
 

Required Qualifications

• Active Oklahoma or Compact Registered Nurse, RN, license 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.

Work Style: Remote Work at Home

Location: Oklahoma

Training Schedule: Must be able to attend training schedule. Monday - Friday; 8:00am - 5:00pm Central Time

Work Schedule:  The department has multiple schedules available:

• Monday through Friday 8:00 AM - 5:00 PM Central Time with rotating holiday and weekend rotations

• Saturday through Wednesday 8:00 AM – 5:00 PM Central Time with rotating holidays

• Friday through Tuesday 8:00 AM – 5:00 PM Central Time with rotating holidays

• Sunday through Thursday 8:00 AM – 5:00 PM Central Time with rotating holidays

Travel: Minimal travel for office meetings 1-2 times annually as business needs.

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 recommended; 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

Preferred Qualifications

• 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 a plus (CCM).

• Experience working with MCG or Interqual guidelines.

• Triage experience a plus.

• Health Plan experience working with large carriers.

• Bilingual preferred.

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or