Pre Authorization Behavioral Health Professional 2 - RN

Profile

Description

The Pre-Authorization Behavioral Health Professional 2 reviews prior authorization requests for appropriate care and setting, follows guidelines and policies, and approves services or forwards requests as needed. The Pre-Authorization Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Location: Work at home anywhere however must be located and licensed in a compact state

As a Pre-Authorization Behavioral Health Professional 2 - Registered Nurse you will contribute to the success of Humana's business strategy by collecting broad based information and gathering resources and data in order to arm the team with the tools necessary to enhance consumer engagement, choice, and trust. In this role you will:

Receiving inbound calls from providers, facilities and members to set up initial authorizations for behavioral health services

Determine the needs of callers making appropriate and timely determinations for authorization requests

Make outbound calls to facilities to obtain clinical information, at times Document all calls and attach clinical information received

Understand and engage in risk management procedures such as identifying, coordinating, and following through on quality concerns, sentinel events, complaints, and performance standards;

Participate in all quality improvement procedures and adhere to quality improvement standards;

Abide by the policies and procedures of the department

Potential to work weekend rotation

Additional responsibilities as deemed appropriate by Humana leadership

Please note this role will require the ideal candidate to work until 6:30 PM CST Mon-Thur. and 6 pm CST Fridays

Required Qualifications

Degree in Nursing

Possess a current, valid, and unrestricted license from list: Registered Nurse (RN) with Compact License and general New York License

3 years of practice experience

1 or more year of post-degree clinical experience in private practice or other patient care

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Registered Nurse (RN) with Compact License, General New York License and Registered Nurse (RN) in one of the following states: West Virginia, New York, Massachusetts, or Rhode Island

Experience with behavioral change, health promotion, coaching and wellness

Experience working with the older adult population

Knowledge of community health and social service agencies and additional community resources

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com