Pre-Authorization Registered Nurse

Company: Humana | Location: Remote, Virginia | Salary: $71,100 to $97,800 per year | Employment: Full-time | License: RN | State licensure: Virginia

Become a part of our caring community The Pre-Authorization Nurse 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse 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, s