Utilization Management Behavior Health - Registered Nurse Compact State License

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, California, Ohio, or Nevada preferred however must be located and licensed in a Compact State

The Utilization Management Behavioral Health Professional 2 - Registered Nurse completes telephonic and/or faxed reviews with the Utilization Reviewer at the Behavioral Health Facility to obtain sufficient clinical information for all levels of facility based behavioral health treatment. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.

Complete telephonic, faxed, and voicemail reviews with facilities

Assess discharge plans

Coordinates with Care Coordination and Case Management

Discuss cases with Medical Directors in daily rounds

Complete documentation for Quality Reviews for Peer Reviews

Department hours are Monday - Friday 7am - 6:30 p.m. CST or 8am - 7:30 p.m. EST, shifts are based on business need and can change at any time

Minimal travel required

Required Qualifications

Minimum of Associates Degree in Nursing

Licensed as a Registered Nurse (RN) with a Compact State license

Minimum of 3 year of post-degree Behavioral Health facility-based clinical experience

Minimum of 1 year of managed care experience

Proficiency with Microsoft Office products

Proficient working with computers

Professional verbal and written communication skills

Must have a private office with a locked door

Hard wire high speed DSL or cable modem service (10 Mbps down x 1Mbps up, Minimum), which applicant is required to provide

Preferred Qualifications

Experience with utilization review experience

Bachelor of Science (BSN)

Utilization review or triage experience

Previous Medicare experience

Previous experience working from home

Health plan operations experience

Knowledge of Humana systems and clinical programs

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

Additional Information

Scheduled Weekly Hours

40

Company info

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