Job added in hotlist
Applied job
Contract job
90-day-old-job
part-time-job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in Portland, ME
View more jobs in Maine

Job Details

Pre-Authorization Behavioral Health Professional 2 - Registered Nurse

Company name
Humana Inc.

Location
Portland, ME, United States

Employment Type
Full-Time

Industry
Healthcare, Nursing, Bilingual

Posted on
Apr 20, 2021

Apply for this job






Profile

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

Company info

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

Similar Jobs:
Type of Requisition: Regular Clearance Level Must Be Able to Obtain: None Job Family: Functional Experts We are GDIT. The people supporting and securing some of the most complex government defense, and intelligence projects ...
Type of Requisition: Regular Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: None Job Family: Functional Experts We are GDIT. The people supporting and securing some of the most complex government...
Type of Requisition: Regular Clearance Level Must Be Able to Obtain: None Job Family: Functional Experts We are GDIT. The people supporting and securing some of the most complex government defense, and intelligence projects ...
EmploymentCrossing provides an excellent service. I have recommended the website to many people..
Laurie H - Dallas, TX
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
BilingualCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
BilingualCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2021 BilingualCrossing - All rights reserved. 169 192