Pre Authorization Behavioral Health Professional 2 - RN
Humana

Job Info

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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

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