RN - UM Behavioral Health

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 and/or benefit administration determinations. 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: Work at home anywhere 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

Required Qualifications

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

Registered nurse with Compact Licensure (licensed and located in compact state)

BSN degree

Minimum of three (3) years of post-degree clinical experience in direct patient care

Three (3) years or more of Behavioral Health experience

Minimum of two (2) years of utilization management experience

Proficiency with Microsoft Office products

Adept experience working with computers

Preferred Qualifications

Master's degree in nursing

Use of EMR systems

Additional Non-compact nursing licenses

Knowledge of community health and social service agencies and additional community resources

Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com