Utilization Management Behavioral Health Nurse 2- Compact Licensure Required -Remote position

Profile

Description

The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications

NOTE: Our department is available Monday - Friday from 7:00 AM-6:30 PM CST .

Hours for this role are based on business need between that timeframe.

Minimum of Associate's Degree in Nursing

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

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 Behavioral Health utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.

One (1) year of managed care experience working directly with insurance companies

Proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote

Adept experience working with computers

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

BSN degree

Master's degree in nursing

Use of EMR systems

Additional Non-compact nursing licenses

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

Additional Information

NOTE: Our department is available Monday - Friday from 10:00 AM-6:30 PM CST .

Hours for this role are based on business need between that timeframe.

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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 Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Vaccination Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

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