25 days old

RN Supervisor, Medicare Precertification - Miami, FL

Humana
North Miami Beach, FL 33261
Description 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. Responsibilities This is an office based position in Miami, FL. The hours are Mon-Fri, 8am-5pm est, with rotating Saturdays approx every 4-6 weeks. 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 are related to schedule, plans and daily operations. + Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. + Ensures consistency in execution across the team and holds team members accountable for following established policies. Required Qualifications + Bachelor's Degree + 3-5 years of managed care experience + Current RN license in FL with ability to be licensed in multiple states without restrictions + 1 year of progressive clinical experience + Prior supervisory experience + Strong communication skills, both verbal and written + Excellent computer skills and ability to easily navigate multiple applications + Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications + Bilingual - English/Spanish + Health Plan experience + Prior Medicare / Medicaid experience 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 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2019-09-20 Expires: 2019-10-20

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RN Supervisor, Medicare Precertification - Miami, FL

Humana
North Miami Beach, FL 33261

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