RN, Utilization Management Behavioral Health – Nationwide

Location: San Antonio, TX
Additional Location: Birmingham AL; Phoenix AZ; Rogers AR; Torrance CA; Colorado Springs CO; Bridgeport CT; Dover DE; Tampa FL; Atlanta GA; Meridian ID; Chicago IL; Indianapolis IN; Davenport IA; Overland Park KS; Louisville KY; Metairie LA; Portland ME; Bethesda MD; Boston MA; Troy MI; Minneapolis MN; Ridgeland MS; Springfield MO; Billings MT; Omaha NE; Las Vegas NV; Portsmouth NH; Jersey City NJ; Albuquerque NM; Albany NY; Charlotte NC; Fargo ND; Cincinnati OH; Tulsa OK; Salem OR; Pittsburgh PA; Newport RI; Lancaster SC; Aberdeen SD; Brentwood TN; Sandy UT; Montpelier VT; Glen Allen VA; Vancouver WA; Green Bay WI;
Schedule: Full_time
Req: R-313324

Description

The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations.

Responsibilities

This department is available Monday – Friday from 8:00 AM-6:30 PM CST.

Hours for this role are based on business need between that timeframe.

The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

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
• Must be able to work Monday – Friday from 8:00 AM to 4:30 PM CST.
• Potential for occasional weekends and/or holidays coverage.

Preferred Qualifications

• Advanced nursing degree: BSN or MSN
• Behavioral Health direct patient care experience preferred
• Experience with Behavioral Health 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
•    Parental Leave
•    Go365 perks for well-being

Additional Information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

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.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review 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.

As part of our hiring process for this opportunity, we will be using an exciting 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.

#LI-Remote

This position is remote nation

Scheduled Weekly Hours

40