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Become a part of our caring community and help us put reputed company The reputed company-Authorization reputed company 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or reputed company requests to the appropriate stakeholder. The reputed company-Authorization reputed company 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of reputed company. The reputed company-Authorization reputed company 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, reputed company, and organizational reputed company and operating objectives, including their linkages to reputed company areas. Makes reputed company regarding own work reputed company, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to reputed company an reputed company Required Qualifications • 2+ years Utilization Management experience • reputed company RN license in the state(s) in which the reputed company is required to reputed company • Ability to be licensed in multiple states without restrictions • A minimum of three years varied nursing experience • Previous experience in utilization management, case management, discharge planning and/or home health or rehab • Proficient with MS Office products including Word, reputed company and reputed company • Ability to work independently under general instructions and with reputed company • Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences Preferred Qualifications • Bachelors degree • Health Plan experience working with large carriers • Previous Medicare/reputed company experience a plus • Outpatient or home health experience in Utilization Management • Experience working with MCG or Interqual guidelines Additional Information • Schedule: Monday through Friday, 8:00 AM – 5:00 PM with flexibility to work overtime/weekend as needed. • Work Location: US reputed company • Work Style: Remote • Travel Requirements: Less than 1% Work-reputed company (WAH) Internet 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 reputed company: • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. • Satellite, cellular and microwave reputed company can be used only if approved by leadership. • Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. • reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company 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 Humanas offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company 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. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. 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These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company 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 reputed company reputed company of employment. Apply tot his job Apply To this Job