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

Location: Work at home in any location but must be in a Compact state

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 7-6:30 p.m. CST, shifts are based on business need and can change at any time


Required Qualifications


Degree in Nursing
Must be licensed in a Compact State
Registered Nurse (RN) or other professional license
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 one (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


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

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

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Company info

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