RN, Utilization Management - Behavioral Health - Remote US

Become a part of our caring community and help us put health first
 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, at least three (3) years of clinical and Utilization Management experience.

The Utilization Management Behavioral Health Nurse completes medical record reviews from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information. The UM Behavioral Health RN 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

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.

Use your skills to make an impact
 

Required Qualifications

• Minimum of Associate’s Degree in Nursing
• Registered nurse with active Compact Licensure and no disciplinary actions
• Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
• 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 …