Job Details

Utilization Management Behavior Health Professional 2 - Registered Nurse

Location
Cincinnati, OH, United States

Posted on
May 10, 2021

Apply for this job






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

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 7-6:30 p.m. CST, shifts are based on business need and can change at any time


Required Qualifications


Minimum of Associates Degree in Nursing
Must be licensed in a Compact State
Licensed as a Registered Nurse (RN)
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


Preferred Qualifications


Experience with utilization review process
Experience with behavioral change, health promotion, coaching and wellness
Experience working with the older adult population
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 may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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 **** with instructions to add the information into the application at Humana's secure website

Scheduled Weekly Hours

40

Company info

Sign Up Now - HealthcareCrossing.com

Similar Jobs:
Description Bring your unique talents and perspectives to Humana and help us bring better healthcare solutions to our members. At Humana, you'll have the opportunity to interact with members, provide professional advice, and enab...
Description The Senior Clinical Business Professional assists in the development and stabilization strategy of all Care Management program activities in all existing, new and expansion markets. This role will assist in identifyin...
STNA; CNA; & Home Health Aide
Location : Cincinnati, OH
A Miracle Homecare Currently looking to fill HHA positions in Cincinnati, Ohio . Flexible schedules, potential for bonus, and the sense of fulfillment as you are helping people in need. Start your new career with no experience nee...
EmploymentCrossing was helpful in getting me a job. Interview calls started flowing in from day one and I got my dream offer soon after.
Jeremy E - Greenville, NC
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
HealthcareCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
HealthcareCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2025 HealthcareCrossing - All rights reserved. 169 192