RN Utilization Management, Behavioral Health

Become a part of our caring community and help us put health first
 The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services.

Enjoy the flexibility of Work-At-Home for a company that values your personal well-being. Humana offers a full array of competitive benefits and professional growth opportunities, in addition to unique offerings such as early access to pay and various wellness programs designed to help you live your best life.

To be considered, you must have an active compact (Multistate) license and experience in Behavioral Health. #LI-Remote

This is a Full-Time, Remote Telephonic RN opportunity, however must be located and licensed in a Compact State

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.

• 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. Individual shift will be assigned within these hours.​

What it takes to be successful in this role:

• Willingness to work Monday to Friday, 8am - 4:30pm Central Standard Time (CST)

• Flexible and able to adapt to an ever-changing environment.

• Strong attention to detail.

Use your skills to make an impact
 

Required Qualifications

• Minimum of Associate Degree in Nursing

• Registered Nurse (R.N.) licensure with no disciplinary action.

• 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 with adult population

• Must have experience in a Behavioral Health setting.

• Proficiency with Microsoft Office products: Outlook, Word & Excel

• Adept at working via a computer: on multiple screens, in multiple platforms, and comfortable learning new programs.

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Desired Qualifications

• Bachelor's or advance degree

• Experience in Behavioral Health, Utilization Management and/or Behavioral Health utilization management experience (performing medical necessity reviews against criteria such as …