RN - UM Behavioral Health

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


Required Qualifications

NOTE: Our department is available Monday - Friday from 7-6pm CST. Hours for this role are based on business need between that timeframe.


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


Preferred Qualifications


Master's degree in nursing
Use of EMR systems
Additional Non-compact nursing licenses
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 will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

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

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