Remote RN, Utilization Management – Behavioral Health, Nationwide

Humana

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Location: Nationwide
Location Type: Remote
Schedule: Full_time
Req: R-336197

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, at least three (3) years of clinical and Utilization Management experience.

 

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

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.

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
  • Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
  • 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
  • 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

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

 

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

 

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 personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

 

Equal Opportunity Employer

 

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.