Humana is looking for a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. Reporting to the Utilization Management Supervisor, you will review the clinical appropriateness of prior authorization (PA) requests. You will ensure that all benefits authorized meet medical necessity and other Medicare and Medicaid criteria if applicable, to promote cost-effective delivery of health care services. You will work from remotely from home. You will develop your skills all while doing your part to improve the lives of others.
**Essential Duties and Responsibilities:**
+ Review PA requests outpatient services according to applicable Medicare and Medicaid criteria, iCare guidelines, and PA Department procedures. + Provide complete and accurate documentation specifying rational for approval, or for forwarding to the CMO/Medical Director for further review. + Create reduction/denial letters based on the ...