Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Pre-Authorization Behavioral Health Professional 2

Humana - Work At Home, Florida

Posted: 12/7/2018

Description

The Pre-Authorization Behavioral Health Professional 2 is part of a queue based team that 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

The Pre-Authorization Behavioral Health Professional 2 completes medical necessity review and level of care review for requested services, using clinical judgment, and refers to Medical Directors for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Work hours:

  • Monday- Thursday 10:00 - 6:30 CST
  • Friday 9:30 - 6:00 CST

               

Additional Job Description

Required Qualifications

Preferred Qualifications

  • Master's degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university
  • Less than 5 years of Microsoft Office experience (Word, Excel, Outlook)
  • Possess a current, valid, and unrestricted license from list: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license
  • 3 three years practice experience
  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care
  • Excellent communications skills, both written and verbal
  • Experience with behavioral change, health promotion, coaching and wellness
  • Knowledge of community health and social service agencies and additional community resources
  • Able to work independently, under general instruction
  • Ability to type at least 38 WPM

Scheduled Weekly Hours

40

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