The Supervisor, 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 Supervisor, Pre-Authorization Nursing works within thorough, prescribed guidelines and procedures; uses 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.
The Supervisor, Pre-Authorization Nursing 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
- Decisions are typically related to schedule, plans and daily operations
- Performs escalated or more complex work of a similar nature, and supervises a group of typically nurses and support associates
- Coordinates and provides day-to-day oversight of associates and production metrics. Ensures consistency in execution across team
- Conducts briefings and area meetings
- Holds team members accountable for following established policies
- Assists with other department duties and/or projects as assigned by leadership
- Current Unrestricted RN licensed in Florida with no disciplinary action
- 3 years of utilization management related experience
- 2 years progressive clinical experience preferably in an acute care clinical setting
- Prior supervisory experience or experience with leading a team
- Proficiency in Microsoft Office Word, Excel and PowerPoint
- The hours for this position are 8AM- 5 PM Monday- Friday Eastern Time, with occasional overtime and rotating coverage during weekends and holidays to support business needs.
- You will be expected on occasion to report to the Market office for meetings
Work At Home Requirements
- For this job, associates are required to be fully COVID vaccinated 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. We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.
- If progressed to offer, you will be required to:
- Provide proof of full vaccinationor commit totesting protocolsOR
- Provide proof of applicable exemption including any required supporting documentation
- Medical, religious,stateand remote-only work exemptions areavailable.
- Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
- Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Additional InformationOnsite Travel
- Bachelor's Degree
- Health Plan experience
- Prior Medicare / Medicaid experience
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 #WorkAtHomeInterview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed
) inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.Scheduled Weekly Hours
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