A productive and enjoyable place to work
LVN/Clinical Nurse Advisor (Former Employee) – San Antonio, Tx – April 11, 2013
Initially, as I stated in the resume section, my job consisted of reviewing Pre-autorization request for services being requested by Humana members. I would contact the requesting provider to clarify the information and to request clinical information on the member that will allow me to make a determination. I would then compare that information (the member's medical history, signs and symptoms, photographs, ect) to their Humana contract, and the state or federal criteria and guidelines depending on the type of insurance. I would determine if the service was a covered benefit, and if it was, I would then determine if the member qualified for the service. If the member qualified, I would approve the request at my level and make notifications. If I could not approve, then the requested was forwarded, using Humana's standards, to a medical director for review. Once a determination was made by the medical director, notifications were made and a denial letter was written, reviewed, and mailed as necessary.
humana provided a comfortable environment to work in.
since i was salary, i would often work 6 or more hours of overtime a week without compensation.