Humana

About Humana

 

Job Category:

Member Quality & Financials - Utilization Management

Country:

United States

Postal Code:

33101

Approximate Salary:

Not Specified

Position Type:

Full time

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Pre-Authorization Nurse - Doral, FL

Humana - Miami, Florida

Posted: 07/4/2018

Description

The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

This is an office based role. The hours are Mon-Fri, 8am-5pm est.

The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains 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.

               

Required Qualifications

  • RN or LPN license in FL without restrictions
  • Acute hospital experience
  • Strong assessment skills in adult acute care
  • Proficient in Word, Excel and Outlook and ability to easily navigate multiple applications
  • Ability to work independently under general instructions and with a team

Preferred Qualifications

  • Previous Medicare/Medicaid experience a plus
  • Previous experience in utilization management, case management, discharge planning and/or home health or rehab
  • Experience working with MCG or Interqual guidelines

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40

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