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Prior Authorization RN at Humana - ApplyBlast

Prior Authorization RN

Humana

4 months ago

3.6 on Glassdoor

Remote

Full Time

Junior

0 applicants

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About this role

Humana is seeking a Prior Authorization Registered Nurse to review clinical appropriateness of requests within the Wisconsin Medicaid Market. The role involves ensuring benefits meet medical necessity and Medicare/Medicaid criteria while promoting cost-effective healthcare delivery. This position requires collaboration with staff and maintaining a thorough understanding of applicable guidelines.

Responsibilities

Review prior authorization requests for outpatient services
Ensure benefits meet medical necessity and regulatory criteria
Create reduction or denial letters based on medical director reviews
Stay informed about Medicare and Medicaid guideline changes
Collaborate with PA staff to complete department workflows

Skills

Qualifications

Licensed Registered Nurse in WisconsinBachelor of Science in NursingValid Compact LicenseClinical Care ExperienceUtilization Management Experience

About Humana

humana.com

Headquarters

Louisville, Kentucky, United States

Company Size

10001+ employees

Founded

1961

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