Full-Time Remote, Telephonic RN opportunity.

The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services.

Enjoy the flexibility of Work-At-Home, from anywhere in the US, for a company that values your personal well-being. To be considered, you must have an active compact (Multistate) license and at least three (3) years of clinical experience.

Responsibilities

This department is available Monday – Friday from 7:00 AM-5:30 PM CST. Hours for this role are based on business need between that time frame. Individual shift to be discussed during the interview.

The Utilization Management Behavioral Health Nurse 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. Duties include:

• 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

• Minimum of Associate’s Degree in Nursing
• Registered nurse with active Compact Licensure and no disciplinary actions
• Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)
• Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote

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

• Advanced nursing degree: BSN or MSN
• Behavioral Health direct patient care experience preferred
• Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
• 1 year of managed care experience working directly with insurance companies
• Use of EMR systems
• Additional Non-compact nursing licenses
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Scheduled Weekly Hours

40