Become a part of our caring community and help us put health first
 

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.

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 UM Behavioral Health RN 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.

Use your skills to make an impact
 

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

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

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

How we Value You  
•    Benefits starting day 1 of employment 
•    Competitive 401k match  
•    Generous Paid Time Off accrual  
•    Tuition Reimbursement 
•    Parent Leave 
 

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$69,800 - $96,200 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage pe