[Hiring] Behavioral Health Registered Nurse Intern @Humana

Role Description

Become a part of our caring community. Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first? The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with main training to perform your internship. You will partner with your team to support members, projects, and to meet goals affecting outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members.

The Utilization Management Behavioral Health Registered Nurse (RN) Intern will report to a manager of the National Medicaid team. You will use training and engage formerly acquired skillsets to complete medical necessity reviews for behavioral health requested services using clinical judgment and provide referrals to internal stakeholders for further review depending on case findings.

You will participate in the following assignments in this role:

• Clinical Review:
  • Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility.
  • Apply advanced evidence-based clinical guidelines in review decisions.
  • Ensure compliance with accreditation, state, and federal regulations.
• Communication and Coordination:
  • Communicate with healthcare providers to obtain necessary clinical information and clarify requests.
  • Coordinate with medical directors and interdisciplinary teams to support decision-making.
  • Promote communication between clinicians, internal departments, and members.
• Documentation and Reporting:
  • Document all review findings and decisions in clinical documentation systems.
  • Ensure timely and accurate documentation of prior authorization determinations.
  • Support reporting programs and provide data for performance improvement projects.
• Quality Assurance:
  • Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions.
  • Conduct regular audits and reviews to maintain high standards of service.
  • Identify process improvement opportunities and contribute to performance improvement projects.
• Education and Training:
  • Educate providers and staff on prior authorization policies, criteria, and review processes.
  • Provide mentorship and feedback to nonclinical staff and peers to enhance workflow efficiency.
  • Stay current with clinical best practices and regulatory changes.

Qualifications

• You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship.
• Active Registered Nurse, RN, in the state of Kentucky or an enhanced Compact (eNLC) license without restrictions or disciplinary action.
• Minimum two (2) years of clinical behavioral health experience.
• Proficiency in healthcare software and electronic medical records (EMR) systems.
• Have an interest in working in the managed care industry.

Requirements

• Bachelor's degree (preferred).
• Previous Medicare/Medicaid experience (preferred).
• Previous experience in prior authorization, utilization management (preferred).
• Experience working with MCG or Interqual guidelines (preferred).
• Certification in Case Management (CCM) or Utilization Review (UR) (preferred).
• Knowledge of payer policies, insurance companies, and government health programs (preferred).

Benefits

• Work from home with high-speed internet requirements.
• Networking opportunities while participating in the Internship or Fellowship.
• Potential for mentorship and professional development.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.