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About the role
Key responsibilities & impact- Review prior authorization requests for appropriate care and setting
- Follow guidelines and policies to approve services or forward requests to the appropriate stakeholder
- Complete medical necessity and level of care reviews using clinical judgment
- Refer cases to team members for review based on findings
- Educate providers on utilization and medical management processes
- Enter and maintain clinical information in medical management systems
- Interpret department, segment and organizational strategy and operating objectives
- Make independent decisions regarding work methods and follow established procedures
- Occasionally travel to Humana offices for training or meetings
Requirements
What you’ll need- 2+ years of RN experience
- Active RN license in the state of Indiana
- Ability to be licensed in multiple states without restrictions
- Previous experience in utilization management, case management, discharge planning and/or home health or rehab
- Proficient with MS Office products including Word, Excel and Outlook
- Ability to work independently under general instructions and with a team
- Minimum internet speed of 25 Mbps download and 10 Mbps upload for home work
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Dedicated home workspace requirement supporting remote work
- Self-provided internet service with minimum 25 Mbps download and 10 Mbps upload