Company name
Humana Inc.
Location
San Juan, PR, United States
Employment Type
Full-Time
Industry
Healthcare, Nursing, Bilingual, Case Management
Posted on
Nov 20, 2020
Profile
Job Information
Humana
Pre-Authorization Nurse 2 - Work at Home from PR ONLY
in
San Juan
Puerto Rico
Description
The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward 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.
Responsibilities
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. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Registered Nurse from an accredited institution
Active RN license without restrictions in Puerto Rico
Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico)
Prior clinical experience in an acute care, skilled nursing, rehabilitation, OR discharge planning
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Health Plan experience
Previous Case Management Experience
Call center or triage experience
Previous experience managing Medicare members
Bilingual English/Spanish. Candidate selected will not be communicating in English with members.
Additional Information
Schedule:
Monday to Friday 8:30AM - 5:30PM, overtime
Address:
Work At Home from PR Only . Office is located at:
383 Ave FD Roosevelt | San Juan, PR, 00918-2131
Training: 6 months on site
ON CALL - Availability
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com