**Become a part of our caring community**

Humana is seeking a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid Market (iCare) team. Reporting to the Supervisor of Pre-Authorization Nursing, 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/or Medicaid criteria to promote cost-effective delivery of health care services.

**Responsibilities:**

+ Review authorization requests for inpatient and outpatient behavioral health care following applicable Medicare and Medicaid criteria, Humana/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 under...