Pre-Authorization Nurse

21 hours ago


Oklahoma City, Oklahoma, United States Humana Full time
Join Humana's Team as a Pre-Authorization Nurse

We are seeking a skilled Pre-Authorization Nurse to join our team at Humana. As a Pre-Authorization Nurse, you will play a critical role in reviewing prior authorization requests for appropriate care and setting, following guidelines and policies, and approving services or forwarding requests to the appropriate stakeholder.

Key Responsibilities:
  • Review prior authorization requests for medical necessity and appropriateness of care and setting
  • Apply clinical judgment to make decisions regarding service approvals or referrals
  • Collaborate with internal stakeholders to ensure accurate and timely reviews
  • Provide education to providers on utilization and medical management processes
  • Enter and maintain pertinent clinical information in medical management systems
Requirements:
  • Active Oklahoma or Compact Registered Nurse, RN, license without restrictions or disciplinary action
  • Minimum Two (2) years clinical nursing experience in acute care, emergency room, ICU, skilled or rehabilitation setting
  • Working knowledge of MS Office, including Word, Excel, PowerPoint, and Teams in a Windows-based environment
  • Ability to work independently under general instructions and with a team
What We Offer:
  • Competitive salary and bonus incentives
  • Comprehensive benefits package, including medical, dental, and vision coverage
  • 401(k) retirement savings plan with employer match
  • Opportunities for career growth and professional development

At Humana, we value our employees and strive to create a work environment that is inclusive, supportive, and empowering. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.


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