Utilization Management Behavioral Health Nurse 2- Compact Licensure Required - RN

Profile

Description

The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Location: Remote however must be located and licensed in a Compact State

The Utilization Management Behavioral Health Professional 2 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.


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
Our department is available Monday - Friday from 7:00 AM-6:30 PM CST. Hours for this role are based on business need between that timeframe


Required Qualifications


Minimum of Associate Degree in Nursing
Registered nurse with Compact Licensure (licensed and located in compact state)
Minimum of three (3) years of post-degree clinical experience in direct patient care
Proficiency with Microsoft Office products: Word & Excel
Adept experience working with computers and comfortable learning new programs
Must have the ability to provide a high speed DSL or cable modem for a home office
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


Desired Qualifications


BSN degree
Master's degree in nursing
Three (3) years or more of Behavioral Health experience
Minimum of two (2) years of Behavioral Health utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
One (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

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

Scheduled Weekly Hours

40

Company info

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