Pre-Authorization Nurse
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Pre-Authorization Nurse coordinating military beneficiary care, quality reviews, transfers, and discharge planning for Humana’s healthcare services.
Responsibilities:
- Coordinate care for MHS beneficiaries receiving care outside the MTF
- Monitor quality of care
- Identify and document potential quality issues regarding patient care
- Coordinate patient transfers
- Document in MSR
- Review inpatient outlier cases
- Ensure appropriate discharge planning
- Refer cases to Tier III care management as needed
- Report to a Supervisor of Pre-Authorization Nursing
Requirements:
- U.S. citizenship required
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
- Candidates currently living in Puerto Rico cannot be hired for this position
- Registered Nurse with current in-state RN license
- At least 3 years of varied clinical RN nursing experience
- TRICARE experience
- Knowledge of MCG evidence-based criteria or comparable criteria such as InterQual
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Self-provided home internet service requirements/support for remote work
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings
Similar Jobs
Registered Nurse, Utilization Management
Utilization Management RN reviewing medical necessity and admission status at UVA Health. Supporting payer authorization, regulatory compliance, and patient-centered outcomes.
Case Manager, Registered Nurse – Medicare
Remote Registered Nurse Case Manager coordinating Medicare members’ comprehensive care. CVS Health delivers connected, compassionate healthcare and wellness support.
Case Manager, Registered Nurse – Medicare
Remote Medicare Case Manager RN coordinating comprehensive member care, benefits, and wellness for CVS Health. Collaborating with members, providers, and community organizations to improve outcomes.
Care Coordinator, LPN
LPN coordinating remote kidney-care outreach, assessments, and documentation for Evergreen Nephrology’s value-based care programs. Supporting patients, providers, and care teams through chronic kidney disease management.
Grievance & Appeals Nurse, RN
RN handling California health-plan grievances, appeals, and quality-of-care cases for IEHP. Coordinating member care and regulatory reporting across providers and internal teams.
Patient Support Nurse
Patient Support Nurse guiding oncology patients and caregivers through treatment access and education. Supporting Valeris’ life sciences clients with phone-based patient support.
Medical Management Nurse, California
Medical Management Nurse reviewing complex inpatient cases for Elevance Health’s California HMO. Determining medical necessity, consulting Medical Directors, and supporting safe discharge planning.
Care Manager, Telephonic Registered Nurse
Telephonic RN care manager supporting Humana Medicare members with chronic conditions and transitional care needs. Coordinating personalized care plans, resources, and interventions to improve outcomes and independence.
Case Manager, Registered Nurse
Remote registered nurse case manager coordinating personalized care, utilization reviews, and hospital-to-home transitions. Supporting CVS Health’s connected, compassionate healthcare experience.
LPN – Licensed Practical Nurse, Quality Data Specialist
Licensed Practical Nurse auditing medical records and quality data for Geisinger, a nationally recognized healthcare provider. Supporting regulatory compliance, patient safety, and clinical excellence.
Advice Nurse, Behavioral Health
Virtual Mental Health Intake RN conducting psychiatric and chemical dependency intake screenings for Sutter Health. Providing crisis triage, mental status assessments, referrals, and patient placement remotely.
LPN Telephonic Nurse – Ophthalmology, Oncology
LPN providing telephonic patient support, education, referrals, and data collection for UBC’s pharmaceutical support programs. Serving patients, healthcare professionals, and consumers by phone.
Claims Review Nurse
Claims Review Nurse resolving healthcare claim disputes for Capitol Bridge’s Florida and multi-state medical review programs. Assessing documentation, coordinating clinical reviewers, and drafting determinations.
Triage Nurse, RN – Part Time
Remote part-time RN providing early-morning telephone triage for CareXM’s hospice and home health partners. Assessing patients, giving care instructions, coordinating care, and documenting in EHRs.
Registered Nurse, Reviewer
Registered Nurse reviewing Medicare records and preparing physician-review cases for Avar Consulting’s policy research programs. Supporting audits, quality assurance, and Medicare FFS/MA documentation.
Oncology Nurse Educator
Oncology Nurse Educator delivering clinical education for AstraZeneca’s lung and GI cancer medicines. Engaging healthcare providers across the Northwest and supporting patient care strategies.
Licensed Practical Nurse
Licensed Practical/Vocational Nurse delivering in-home care for Caring Hand Home Health Solutions. Providing treatment, education, documentation, and coordination for patients recovering at home.
Registered Nurse
Per-diem Registered Nurse supporting Caring Hand Home Health Solutions’ in-home patient recovery services. Reviewing OASIS assessments, ICD-10 coding, compliance, and clinical documentation quality.
Registered Nurse, Triage Call Agent
Registered Nurse triaging and educating patients by phone for Intermountain Health’s clinical communication center. Assessing needs, documenting calls, and directing patients to appropriate care.
Utilization Review Nurse – Weekends
Utilization Review RN managing evidence-based admission, stay, and discharge reviews at UAMS academic medical center. Coordinating payer communication and interdisciplinary discharge planning.