Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME Anywhere in the US

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Job Information

Humana

Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US)

in

Boston

Massachusetts

Description

The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization Nursing ensures that there's consistency and accuracy within thorough, prescribed guidelines and procedures; encourages and fosters the team's usage of independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Responsibilities

The Supervisor, Pre-Authorization Nursing oversees the daily operations, including planning and scheduling, for the team of 20-25 nurses and medical professionals that performs the following functions: medical necessity/level of care reviews, provider education on the utilization and medical management processes, entering/maintaining pertinent clinical information in various medical management systems.

The supervisor coordinates and provides day-to-day oversight; additionally, the supervisor identifies and provides training and guidance. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Required Qualifications

2 years of Utilization Management (UM), Pre-Auth, or other managed care review experience

Licensed Registered Nurse (RN) in either Florida or a compact state with no disciplinary action.

Current RN license in the state in which the nurse will be required to practice

Previous clinical experience, preferably in an acute or critical care, bedside role

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Ability to travel up to 5%, to attend trainings and meetings, as required

While the normal operating hours of this role are Monday-Friday, 8AM-5PM EST, working overtime (nights/weekends) is often required in this role, as business needs dictate.

Preferred Qualifications

Bilingual (Spanish) strongly preferred

Health plan experience

Prior Medicare/Medicaid Experience

Additional Information

COVID Vaccination Policy:

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including booster, or commit to testing protocols OR  

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available.

Work at Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information - How We Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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