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Preauthorization Registered Nurse
Location
United States + 1 moreAll locations: United States | Trinidad And Tobago
Posted
61 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Preauthorization Registered Nurse
Humana
Become a part of our caring community Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first? The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with key training to perform your internship. You will partner with your team to support members, projects, and to meet goals impacting business outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members. To be eligible for this internship, you must either be a transitioning military service member or a military spouse, and you must obtain eligibility to participate in these DOW sponsored programs. The Prior Authorization, Registered Nurse, RN, Intern will report to a manager of the National Medicaid team. You will utilize training and engage formerly acquired skillsets to complete medical necessity reviews for requested services using clinical judgment and provides referrals to internal stakeholders for further review depending on case findings. You will participate in the following assignments in this role: Clinical Review: - Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility. - Apply advanced evidence-based clinical guidelines in review decisions. - Ensure compliance with accreditation, state, and federal regulations. Communication and Coordination: - Communicate with healthcare providers to obtain necessary clinical information and clarify requests. - Coordinate with medical directors and interdisciplinary teams to support decision-making. - Serve as a liaison between clinicians, internal departments, and members. Documentation and Reporting: - Document all review findings and decisions in clinical documentation systems. - Ensure timely and accurate documentation of prior authorization determinations. - Support reporting initiatives and provide data for performance improvement projects. Quality Assurance: - Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions. - Conduct regular audits and reviews to maintain high standards of service. - Identify process improvement opportunities and contribute to performance improvement projects. Education and Training: - Educate providers and staff on prior authorization policies, criteria, and review processes. - Provide mentorship and feedback to nonclinical staff and peers to enhance workflow efficiency. - Stay current with clinical best practices and regulatory changes. Use your skills to make an impact Required Qualifications: - You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship· - Active Registered Nurse, RN, enhanced Compact, (eNLC) license without restrictions or disciplinary action.· - Minimum two (2) years clinical nursing experience such as 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 and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment. - Possess an interest in working in the managed care industry Preferred Qualifications: - Bachelor's degree - Previous Medicare/Medicaid experience. - Previous experience in prior authorization, utilization management. - Experience working with MCG or Interqual guidelines. - Certification in Case Management, (CCM) or Utilization Review, (UR). - Knowledge of payer policies, insurance companies and government health programs. Workstyle: Remote Work at Home Location: Must reside in a state that participates in the enhanced compact license, (eNLC) Work Schedule: Weekdays 8:00 AM to 4:30 PM Central Time Travel: None Additional Information Work At Home Requirements - WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. - A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. - Satellite and Wireless Internet service is NOT allowed for this role. - A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information The DOW SkillBridge Internship Program provides transitioning military service members time to gain civilian work experience while still on active duty with an employer for a period approved by their command and the DOW, with an average timeline of 90 days. The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks. - Networking opportunities will be provided while participating in the Internship or Fellowship. - Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship. Interview Format As part of our hiring process, we will be using a screening and interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring leaders with an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 1 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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Patient Service Representative-7
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Follow protocols for directly contacting the care centers regarding urgent patient requests and ensure timely follow up Schedules outpatients appointments Generates, prints, and provides patient estimates utilizing price estimator products Inform patient of any outstanding balance, collect balance and co-payment or provide financial assistance information Answers questions or concerns regarding insurance residuals and self-pay accounts Uses knowledge of CPT codes to accurately select codes from clinical descriptions Identifies and/or determines patient Out of Network acceptance into the organization Explains billing procedures, hospital policies and provides appropriate literature and documentation Update/notate all accounts using appropriate standard work Reviews insurance information and determines need for referrals and/or financial counseling. 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Scheduling Specialist I
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Commercial Operator - Nat Gas Scheduler
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Texas, United States of America Job Family Group: Trading Jobs Worker Type: Regular Posting Start Date: April 6, 2026 Business Unit: Trading and Supply Experience Level: Experienced Professionals Job Description: What is the role? The Commercial Operator/ Natural Gas Scheduler – The South Operations team is part of the Commercial North America Gas Operations Team and is responsible for the day-to-day operational management of Shell Energy Americas (SEAm) Natural Gas activities in the South US markets. The scheduler will provide scheduling and operations support to various business desks across North America. 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With Primary working hours being 7:00 am and 7:00pm. The candidate must be able to multi-task and work on 2 different gas days at the same time. What you bring - Must have legal authorization to work in the US on a full-time basis - Bachelor’s degree preferred - 5 or more years of natural gas scheduling experience - Experience in scheduling South US region pipelines preferred - Support retail gas business and knowledge of Gulf Production is a plus - Commercial mindset and ability to work effectively with trade desk in transport optimization, segmentation of pipeline capacity and realization of incremental value through commercial operational decisions - Advanced Knowledge of equity production supply, gathering lines, processing plants and downstream optionality - Proven track record of performance and delivery - Self-starter and ability to effectively multi-task - Ability to work under pressure, prioritize, and meet strict time sensitive deadline - Very strong attention to detail - Strong Team Player, effective communicator, with highly developed interpersonal skills - Ability to adapt quickly to changing internal and external requirements Commercial Acumen - Ability to analyses market information, communicate and act on trading implications - Commercially adept with demonstrated analytical and problem-solving skills Compliance - Knowledge of regulatory requirements for Natural Gas Scheduling preferred Continuous Improvement - Leaner Mindset and continuous improvement mindset would be preferred; ability to suggest and implement process changes and new procedures - Champions continuous improvements (CI) by proactively supporting the forward plan for maintaining and improving systems, tools, data and processes as well as sharing best practices STN Systems - Advanced Excel User with knowledge of formulas, look-ups, linking, pivot tables and macros - Knowledge of internal system; Endur / G-motion experience preferred What we offer The base salary range for this position is $103,000 - $155,000 per year. Individual pay will be based on various factors such as relevant work experience, education, certifications, skill level, seniority, and internal equity. For regular full-time or regular part-time employees of the Company (participating companies as listed in the Summary Plan Description), insurance coverage options include medical, dental, vision coverage, life Insurance, Business Travel Accident Insurance, and Occupational Accidental Death Benefit programs. Employees also participate in a company pension plan and a 401(k) plan. Paid leave includes up to 6 weeks of paid vacation time, up to 11 paid holidays, and parental leave offering 16 weeks of paid leave for birthing parents, and 8 weeks of paid leave for non-birthing parents. Additionally, employees are eligible for short-term disability leave for up to 26 weeks at 100% or 50% of base pay as well as Long-Term Disability insurance. Shell also offers other compensation such financial reimbursement for adoption, wellness, education, and personal learning expenses, and some roles are eligible for discretionary long-term incentives. For interns, eligible benefits include medical, dental, and vision coverage, life insurance, Business Travel Accident Insurance, and Occupational Accidental Death Benefit programs; participation in a 401(k) plan; and paid leave for up to 11 paid holidays. Additional information on Shell’s US benefit programs can be found at https://www.shell.us/careers/about-careers-at-shell/rewards-and-benefits.html. You bring your skills and experience to Shell and in return you work with talented, committed people on one of the most important challenges facing our planet. You’ll have the opportunity to develop the skills you need to grow in an environment where we value honesty, integrity, and respect for one another. You’ll be able to balance your priorities as you become the best version of yourself. - Progress as a person as we work on the energy transition together. - Continuously grow the transferable skills you need to get ahead. - Work at the forefront of technology, trends, and practices. - Collaborate with experienced colleagues with unique expertise. - Achieve your balance in a values-led culture that encourages you to be the best version of yourself. - Benefit from flexible working hours, and the possibility of remote/mobile working. - Perform at your best with a competitive starting salary and annual performance related salary increase – our pay and benefits packages are considered to be among the best in the world. - Take advantage of paid parental leave, including for non-birthing parents. - Join an organisation working to become one of the most diverse and inclusive in the world. We strongly encourage applicants of all genders, ages, ethnicities, cultures, abilities, sexual orientation, and life experiences to apply. - Grow as you progress through diverse career opportunities in national and international teams. - Gain access to a wide range of training and development programmes. We'd like you to know that Shell has a bold goal: to become one of the world’s most diverse and inclusive companies. You can get to know more about how we're working towards that goal, click here. Shell in The United States Shell has been in the US for more than 100 years, leading the sector in energy, petrochemicals and refined products. Today, we provide millions of Americans with the energy needed to heat and cool their homes and power the economy. We operate in all 50 states, from our Deep Water platforms in the Gulf of America to the Pennsylvania Chemicals complex and our miles of pipelines throughout the US. We reach our customers through our 13,000 branded retail stations, and we are number 1 in gasoline sales. We also own the #1 brand of motor oil in the U.S. – Pennzoil® – made from natural gas. We are excited to play a key role in the move to net carbon emissions while providing the oil and gas needed by society for many decades to come - DISCLAIMER: Please note: We occasionally amend or withdraw Shell jobs and reserve the right to do so at any time, including prior to the advertised closing date. Before applying, you are advised to read our data protection policy. This policy describes the processing that may be associated with your personal data and informs you that your personal data may be transferred to Shell/Shell Group companies around the world. The Shell Group and its approved recruitment consultants will never ask you for a fee to process or consider your application for a career with Shell. Anyone who demands such a fee is not an authorised Shell representative and you are strongly advised to refuse any such demand. Shell participates in E-Verify. All qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, age, religion, disability, sexual orientation, gender identity, protected veteran status, citizenship, genetic information or other protected status under federal, state or local laws. Shell is an Equal Opportunity Employer - Minorities/Females/Veterans/Disability. As a US Federal Contractor, hiring selections are subject to periodic audit review and documentation of your selections should be maintained for a period of three calendar years. It is the policy of Shell in the U.S. (“Shell”) to provide equal opportunity to all individuals, employees and all qualified applicants for employment consistent with employment requirements and qualifications. Shell prohibits discrimination based on race, color, sex, national origin, age, religion, disability, sexual orientation, gender identity, veteran status, citizenship, genetic information, or other protected status under federal, state or local laws. All employees are expected to support this policy and contribute to an environment of equal opportunity. If you need an accommodation for a disability during the resourcing process, please speak with an HR representative.



