Pre-Authorization Nurse 2

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

Join our Humana/iCare team as a Pre-Authorization Nurse 2 and play a vital role in our subacute team, ensuring our members receive the right care in the right setting! In this dynamic position, you'll review prior authorization requests, apply clinical guidelines, and collaborate with stakeholders to approve services that help people live their healthiest lives. No two days are ever the same—our nurses use their judgment, expertise, and independent thinking to find the best solutions for every unique situation following established guidelines. If you’re looking for a role where your skills and compassion truly matter, we’d love to welcome you to our team!

Key responsibilities:

• Receive requests for inpatient rehab, long-term acute care hospital, and skilled nursing facilitates. Conduct reviews for medical necessity and appropriate level of care, utilizing clinical judgment and established guidelines
• Adhere to established procedures and guidelines throughout all work activities
• Refer cases to reviewing medical directors and leadership for further review based on findings
• Collaborates, communicates and partners with Care Management teams on discharge planning to ensure a smooth process for members
• Collaborates with the Enrollment department on any eligibility discrepancies between the provider and Humana/iCare team
• Active contributor of the Provider Quality Committee, reviewing requests to ensure members have a safe facility to discharge to
• Provides education to providers regarding utilization management and medical management processes
• Enter and maintain accurate documentation in medical management systems
• Demonstrate understanding of department, segment, and organizational strategy and operating objectives, including their interconnections
• Make independent decisions regarding work methods with minimal supervision

Use your skills to make an impact
 

Required Qualifications

• Associates degree in Nursing
• Active and in good standing RN license for the State of WI
• 2 or more years of nursing experience
• Proficient with MS Office products including Word, Excel and Outlook
• Must be able to work the hours of 8:30-5 pm in Central Standard Time

Preferred Qualifications

• Bachelor's degree in Nursing
• Health Plan experience working with large carriers
• Previous experience in reviewing and managing subacute authorizations
• Previous Medicare/Medicaid experience a plus
• 1 or more years of recent experience in utilization management or case management
• Experience working with MCG guidelines

Additional Information

Additional Information

• Workstyle: Home: Associates Home office environment is their primary work location, but they will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

• Work Location: Wisconsin

• Typical Work Days/Hours: Monday through Friday, 8:30 am – 5:00 pm CST

WAH Internet Statement

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.

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$71,100 - $97,800 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.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.