Utilization Management Nurse Consultant – Behavioral Health (Remote)
CVS Health- Full Time
- Mid-level (3 to 4 years), Senior (5 to 8 years)
Employment Type: Full-time
Become a part of our caring community and help us put health first. The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forwards requests to the appropriate stakeholder. Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action.
As a Pre-Authorization Nurse 2, you will complete medical necessity and level of care reviews for requested services using clinical judgment, and refer to internal stakeholders for review depending on case findings. You will also educate providers on utilization and medical management processes and enter and maintain pertinent clinical information in various medical management systems. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding your own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed, while following established guidelines/procedures.
Use your skills to make an impact!
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.