Healthcare Professional

20 hours ago

Enid, Oklahoma, United States Humana Full time

About the Role

We are seeking a skilled Healthcare Professional to join our team as a Prior Authorization Reviewer. In this role, you will play a critical part in ensuring that patients receive the necessary care and services.

Job Summary

The Prior Authorization Reviewer will be responsible for reviewing prior authorization requests for appropriate care and setting, following guidelines and policies, and approving services or forwarding requests to the appropriate stakeholder. This is an exciting opportunity to make a meaningful impact on the healthcare industry.

Responsibilities

  • Review prior authorization requests for medical necessity and adherence to company policies and procedures.
  • Make decisions regarding approval or denial of services based on clinical judgment and applicable laws and regulations.
  • Communicate with providers, stakeholders, and internal teams to resolve any issues or concerns related to prior authorization requests.
  • Stay up-to-date with changes in laws, regulations, and company policies affecting prior authorization processes.
  • Collaborate with cross-functional teams to ensure smooth operation of prior authorization processes.

Requirements

To be successful in this role, you will need:

  • A minimum of two years of clinical nursing experience in acute care, emergency room, ICU, skilled or rehabilitation setting.
  • An active Registered Nurse (RN) license in the state of Oklahoma without restrictions or disciplinary action.
  • Working knowledge of MS Office, including Word, Excel, PowerPoint, and Teams, in a Windows-based environment.
  • Ability to work independently under general instructions and as part of a team.

Preferred Qualifications

  • Possess an interest in working in the managed care industry.
  • Previous Medicare/Medicaid experience.
  • Experience working with MCG or Interqual guidelines.

Benefits

As a valued member of our team, you can expect:

  • A competitive salary range of $31,200 - $85,100 per year.
  • A comprehensive benefits package, including paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident insurance.

About Us

Humana is committed to putting health first - for our teammates, our customers, and our company. 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.

Equal Opportunity Employer

We are an equal opportunity employer and welcome applications from diverse candidates. Our goal is to create a workplace that reflects the diversity of our community and fosters a culture of inclusivity and respect.

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