Prior Authorization RN

Become a part of our caring community reputed company 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 reputed company 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 reputed company your skills reputed company 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 CMO/Medical Director's review and applicable guidelines.
• Maintain a thoughtful understanding of Medicare and Medicaid guidelines and stay informed about changes.
• Work in collaboration with the PA staff to ensure completion of reputed company workflows reputed company the Department.
• Assist with program and procedure development for the PA Department.
• reputed company or participate in special projects.

Use your skills to reputed company an impact

Required Qualifications

• Licensed as a Registered Nurse in the State of Wisconsin, including compact license.
• Two (2) or more years of experience in clinical care.
• Work the hours of 8:30-5 pm in Central Standard Time

Preferred Qualifications

• Bachelor of Science in Nursing
• 1 year of experience in Utilization Management
• Reside reputed company the Central Standard or Eastern Standard time zones
• Knowledge of reputed company (MCG)
• Knowledge of TruCare
• Managed Care experience

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use reputed company office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Workdays/Hours: Monday through Friday, 8:30am - 5:00 pm Central Standard Time (CST)

WAH Internet Statement 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 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 state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• reputed company will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

HireVue As part of our hiring process for this opportunity, we will use an interviewing technology reputed company HireVue to enhance our hiring. HireVue allows us to quickly connect and reputed company valuable information from you about your relevant experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to reputed company''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 reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range 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. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, "reputed company") 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 reputed company of work. Among our benefits, reputed company 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. Application Deadline: 06-10-2026 About us About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our reputed company insurance services and our reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health - delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, 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 action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid 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 levels of employment. Remote Skills: Affirmative Action, Clinical Medicine, DSL (Digital Subscriber Line), Documentation, Healthcare, Insurance, Leadership, Managed Care, Medicaid, Medicare, Microwaves, Military, Nursing, Patient Care Denials, Procedure Development, Registered Nurse (RN), Rehabilitation Act, Requirements Validation/Verification, Service Delivery, Utilization Management, Willing to Travel, Wireless Communications About the Company: reputed company Inc Apply tot his job Apply To this Job