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Pre-Authorization Nurse

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<h1><b>Become a part of our caring community and help us put health first</b><br> </h1>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 varied and frequently require interpretation and independent determination of the appropriate courses of action.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p>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.</p><p></p><p><b>Responsibilities</b></p><ul><li>Sending and receiving telephonic calls averaging 50% communication with providers</li><li>Educates providers on utilization and medical management processes</li><li>Enters and maintains pertinent clinical information in various medical management systems</li><li>Understands own work area professional concepts/standards, regulations, strategies and operating standards</li><li>Makes decisions regarding own work approach/priorities and follows direction.</li><li>Work is managed and often guided by precedent and/or documented <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">procedures/regulations/professional</span> standards with some interpretation.</li></ul><h1><br><b>Use your skills to make an impact </b><br> </h1><p><b>Required Qualifications</b></p><ul><li><b>Must Reside in Oklahoma</b></li><li>Registered Nurse, licensed in Oklahoma without restrictions</li><li>3+ years of clinical nursing experience</li><li>Intermediate to Advanced 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</li><li>Ability to work independently under general instructions and with a team</li></ul><p></p><p><b>Preferred Qualifications</b></p><ul><li>Health Plan experience working with large carriers</li><li>Previous Medicare/Medicaid experience a plus</li><li>Previous experience in pre-authorization, utilization management, case management, discharge planning and/or home health or rehab</li><li>Experience working with MCG or Interqual guidelines</li></ul><p></p><p><b>Additional Information</b></p><p><b>WAH Internet Statement</b></p><p><span>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:</span><br><br><span>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.</span><br><span>Satellite, cellular and microwave connection can be used only if approved by leadership.</span><br><span>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.</span><br><span>Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.</span><br><span>Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.</span></p><p></p><p></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p>Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.<p style="text-align:inherit"></p><p style="text-align:left"><b>Scheduled Weekly Hours</b></p><p style="text-align:inherit"></p>40<p style="text-align:inherit"></p><p style="text-align:left"><b>Pay Range</b></p>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.<p style="text-align:inherit"><br> </p>$71,100 - $97,800 per year<p style="text-align:inherit"><br> </p>This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.<p style="text-align:inherit"></p><p style="text-align:left"><b>Description of Benefits</b></p>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.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><h1><br><b>About us</b><br> </h1>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.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p>​<br><b>Equal Opportunity Employer</b></p><p></p><p><span>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.</span></p>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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