Utilization Management Behavioral Health Professional 2 - Registered Nurse

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
The hours for this role are Hours are 8-5 CST


Required Qualifications


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


Desired Qualifications


Master's degree in nursing
Use of EMR systems
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

Humana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

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