Utilization Management Behavioral Health Professional 2

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 reviews with the Utilization Reviewer at the Behavioral Health Facilities to obtain sufficient clinical information. 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

Coordinated 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 8-7:30 p.m. EST, shifts are based on business need and can change at any time

Required Qualifications

Associates Degree in Nursing

Must be licensed in a Compact State

Registered Nurse (RN)

Minimum of five (5) years of post-degree clinical experience in direct patient care

Three (3) years or more of Behavioral Health experience

Minimum of three (1) year of utilization management experience or knowledge of the UM process

Proficiency with Microsoft Office products

Proficient working with computers

Desired Qualifications

Experience with utilization review process

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

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

Prefer NY or PA nursing license (must obtain license within 6 months of hire.)

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

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