Humana logo
Humana

Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off

Pre-Authorization Nurse

Location

United States + 9 moreAll locations: United States | United Kingdom | Canada | Germany | France | India | Brazil | Australia | Estonia | Japan

Posted

40 days ago

Salary

$71.1K - $97.8K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Pre-Authorization Nurse

Humana

Role Description The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings. Responsibilities - Send and receive telephonic calls averaging 50% communication with providers - Educate providers on utilization and medical management processes - Enter and maintain pertinent clinical information in various medical management systems - Understand own work area professional concepts/standards, regulations, strategies and operating standards - Make decisions regarding own work approach/priorities and follow direction - Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation Qualifications - Must reside in Oklahoma - Registered Nurse, compact nursing license - 3+ years of clinical nursing experience - Intermediate to Advanced knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment - Ability to quickly learn new systems and troubleshoot basic technical difficulties in a remote environment - Ability to work independently under general instructions and with a team Requirements - Health Plan experience working with large carriers (preferred) - Previous Medicare/Medicaid experience a plus (preferred) - Previous experience in pre-authorization, utilization management, case management, discharge planning and/or home health or rehab (preferred) - Experience working with MCG or Interqual guidelines (preferred) Benefits - Paid time off, holidays, volunteer time and jury duty pay - Recognition pay - 401(k) retirement savings plan with employer match - Tuition assistance - Scholarships for eligible dependents - Parental and caregiver leave - Employee charity matching program - Network Resource Groups (NRGs) - Career development opportunities

Related Categories

Related Job Pages

More Pre-sales Engineer Jobs

Synera logo

Pre-Sales Engineer

Synera

The AI Agent Platform for Engineering

Full TimeRemoteTeam 51-200Since 2018H1B No Sponsor

• Partner with Account Executives, Key Account Managers, and the CRO to drive revenue growth and support strategic deals. • Understand customer challenges and translate them into tailored demos, workflows, and technical presentations. • Design and deliver compelling live demonstrations that showcase the real-world impact of Synera. • Act as a trusted technical advisor to engineering teams and decision makers. • Collaborate with Customer Success to ensure smooth handoffs and successful customer adoption. • Inspire engineers and engineering leaders by showing how automation can transform their workflows. • Continuously learn from customers and share insights with Product, Sales, and Customer Success.

Germany
€73.5K - €95.7K / year
Ingeteam logo

Pre-Sales Engineer, Project Manager

Ingeteam

Electrifying a sustainable future

Full TimeRemoteTeam 1,001-5,000Since 1972H1B Sponsor

• Pre-sales technical support • Project follow-up from receipt of equipment orders through on-site commissioning • Support the sales team with technical product presentations and project pre-sales • Complete technical documentation for tender responses • Perform project sizing/dimensioning • Advise customers in selecting the technical solution for projects in accordance with the technical requirements of the specifications • Take ownership of projects from order receipt through delivery and commissioning • Coordinate with headquarters for the manufacturing of equipment to meet specifications and delivery deadlines • Define and procure the resources required for projects (procurement of equipment and services needed for execution) • Ensure end-to-end project tracking until commissioning (scheduling, progress, customer requirements, assistance at equipment FAT, equipment delivery, deliverables, billing milestones, technical support for the client and commissioning team, financial tracking of the project) • Convey the requirements of the French market to the R&D department based at our headquarters in Spain

France
Job Closed
AnywhereNow logo

Presales Consultant

AnywhereNow

Enable enhanced customer engagement, efficient workforce collaboration and AI driven insights. ⭐HIRING NOW⭐

Full TimeRemoteTeam 201-500H1B No Sponsor

• Identify and design solutions to clients’ technical requirements • Engage in pre-sales technical consultancy, providing technical assistance and guidance during all stages of the presales process • Support with RFP responses • Create and deliver technical and product presentations, both internally and externally • Proactively identify ways of improving the presales processes and team documentation • Support the Professional Services team by providing clear technical requirements for the designed solution

United States
Full TimeRemoteTeam 10,001+Since 1915H1B Sponsor

• Neukundenakquise und Pflege des bestehenden Kundenstamms • Erarbeiten von technischen Lösungen und Präsentation bei unseren Kunden • Beratung von Planungsbüros und Anlagenbauern in Bezug auf Heizungstechnik, sowie Klima- und Kältetechnischen Anlagen • Erstellen kompletter Angebote (Planung/Auslegung/Leistungsverzeichnis/Preis) • Auftragsverhandlungen beim Kunden • Marktbeobachtung und Ausbau des Vertriebsgebietes

Germany
Job Closed