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. 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 follows direction. • Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact Required Qualifications • Must Reside in Oklahoma • Registered Nurse, compact nursing licence • 3+ years of clinical nursing experience • Intermediate to Advanced 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 • Ability to work independently under general instructions and with a team Preferred Qualifications • Health Plan experience working with large carriers • Previous Medicare/Medicaid experience a plus • Previous experience in pre-authorization, utilization management, case management, discharge planning and/or home health or rehab • Experience working with MCG or Interqual guidelines Additional Information WAH Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Benefits • Paid time off, holidays, volunteer time and jury duty pay • Recognition pay401(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 SSN Alert Statement Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [redacted] with instructions on how to add the information into your official application on Humana's secure website. HireVue Statement As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.