Pre-Authorization Nurse

Profile

Description

The Pre-Authorization Nurse 2 reviews Genetic testing 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

Ability to work until 6 CST one Thursday and Friday every other month.

The Pre-Authorization Nurse 2 completes medical necessity reviews for Genetic Testing 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

Active RN license in the state(s) in which the nurse is required to practice

Ability to be licensed in multiple states without restrictions

A minimum of three years varied nursing experience

Proficient with MS Office products including Word, Excel and Outlook

Ability to work independently under general instructions and with a team

Ability to research and understand complex information

Preferred Qualifications

Bachelor's degree

Utilization Management experience

Medicare/Medicaid experience including applying CMS regulations

Past experience in genetics, oncology, laboratory, quality, and or medical policy development

Experience in compiling health-related research, with associated analysis and conclusions.

Additional Information

Working in the state of Arizona must comply with the Tobacco Free Hiring Policy and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for 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 inviting you to participate in a Modern Hire interview. In this interview, you will have a set of interview questions and you will provide recorded video responses to each question. You should anticipate this interview to take about 15 - 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

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