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Humana Pre-Authorization Behavioral Health Professional 2 - Registered Nurse in Troy, Michigan

Description

The WEEKEND 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, must be licensed & reside 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 faxes from providers, facilities and members to set up initial authorizations for behavioral health services

  • Determine the needs on the faxes, 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

  • Additional responsibilities as deemed appropriate by Humana leadership

  • Please note this role may require the ideal candidate to work Friday, Saturday, Sunday and Monday from 8am until 6:30 PM EST.

Required Qualifications

  • Degree in Nursing

  • RN license

  • Compact state RN license

  • Minimum of three (3) years of clinical experience

  • Behavioral Health experience

  • Utilization management experience

  • Must have accessibility to high speed DSL or cable modem for a home office. Please note Satellite internet cannot be used for this role. Internet speeds must be at a minimum of 10Mbps Download by 1Mbps Upload for Cable Broadband.

Desired Qualifications

  • Knowledge of the utilization review process

  • Managed care experience

  • 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

  • Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Additional Information

Humana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

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