RN Utilization Management - Behavioral Health

Profile

Description

Full-Time Remote, Telephonic RN opportunity.

The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services.

Enjoy the flexibility of Work-At-Home, from anywhere in the US, for a company that values your personal well-being. To be considered, you must have an active compact (Multistate) license and at least three (3) years of clinical experience.

Responsibilities

This department is available Monday - Friday from 7:00 AM-5:30 PM CST. Hours for this role are based on business need between that time frame. Individual shift to be discussed during the interview.

The Utilization Management Behavioral Health Nurse completes medical record reviews from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Duties include:


Complete medical record reviews
Assess discharge plans
Review and extract information from claims
Complete documentation for Quality Reviews for Peer Reviews
Discuss cases with Medical Directors
Work in partnership with other members of the Humana Interdisciplinary team
Comply with performance and reporting standards as defined by Humana
Complete additional responsibilities as deemed appropriate by Humana leadership


Required Qualifications


Minimum of Associate's Degree in Nursing
Registered nurse with active Compact Licensure and no disciplinary actions
Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)
Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote


Work-At-Home Requirements


WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


Advanced nursing degree: BSN or MSN
Behavioral Health direct patient care experience preferred
Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
1 year of managed care experience working directly with insurance companies
Use of EMR systems
Additional Non-compact nursing licenses
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish


Additional Information - How we Value You


Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being


Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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