Pre-Authorization Nursing Manager - WAH FL

Profile

Description

The Manager, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Manager, Pre-Authorization Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Pre-Authorization Nursing


Completes medical necessity and level of care reviews for requested services using clinical judgment
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
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area
Requires cross departmental collaboration
Conducts briefings and area meetings
Maintains frequent contact with other managers across the department


Required Qualifications


Bachelor's Degree
Health Plan experience
Current RN licensed in Florida
2 years of management experience
1 - 2 years or more of experience with Reporting, Analytical Skills (identifying trends and evaluating data)
Experience with coaching and developing associates
Progressive clinical experience preferably in a clinical setting
Proficiency in Microsoft Office Word, Excel and PowerPoint
Able to give direction and make sound business decisions
Ability to exercise sound judgement and engage in ethical behavior
Exceptional verbal and written communication skills
Strong attention to detail
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to work Monday-Friday, weekend rotation required


Preferred Qualifications


Prior Medicare / Medicaid experience


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 SMS Text Messaging interview. You should anticipate this interview to take approximately 5-10 minutes.

Additional Information

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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