RN - UM Behavioral Health Professional 2

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Description

Job Summary

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 completes telephonic and/or electronic 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. This individual will utilize behavioral health knowledge and skills to work with identified members to assess their care needs, assist in planning and implementing interventions to meet those needs, assist in coordinating services, and monitoring and evaluating the case management plan against the member's personal health care goals. In this role, you will:


Complete telephonic reviews with facilities
Assess discharge plans
Coordinated with Care Coordination and Case Management
Discuss cases with Medical Directors
Complete documentation for Quality Reviews for Peer Reviews
Communicate with members that were recently discharged from facility based care
Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
Assist members in achieving stability and improved well-being in their community
Facilitate wrap-around planning for members who have had recent inpatient utilization
Understand clinical program design, implementation, and management, monitoring and reporting
Work collaboratively 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
Hours: 8 hour shifts to meet business need 7:30-6:30 CST


Required Qualifications


Degree in Nursing
RN license
Compact state RN license
Minimum of three (3) years of clinical experience
Three (3) years or more of Behavioral Health experience
Proficiency with Microsoft Office products
Experience working with computers


Preferred Qualifications


Minimum of two (2) years of utilization management experience
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


Additional Information

Working in the state of Arizona must comply with the Tobacco Free Hiring Policy and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

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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