Location Type: Remote
About this job
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 role is part of the weekend coverage team and the schedule will include every Friday, Saturday, and Sunday. Additional day(s)/shift hours will be discussed in the interview or at time of offer. Shift options include 4, 10-hour shifts or 5, 8-hour shifts.
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
Use your skills to make an impact
- 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
- 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 25×10 (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
- 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
How we Value You
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Perks for well-being
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a SMS Text Messaging interview. You will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.
Scheduled Weekly Hours
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 decisions 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.
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.
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