[Hiring] Behavioral Health Nurse @Humana

Role Description

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

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Follows established guidelines/procedures.

Qualifications

• Registered Nurse (RN) in Indiana
• Health professional with a minimum of an associate's degree in nursing (ASN) from an accredited university. BSN preferred.
• 1 or more years of post-degree clinical experience in private practice or other patient care.
• 1 or more years of managed care experience.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Must reside in the state of Indiana.

Requirements

• Bachelor's Degree (preferred)
• Experience with utilization review process
• Previous experience with MCG, ASAM, and medical policy reviews
• Experience with behavioral change, health promotion, coaching, and wellness
• Experience working with the older adult population
• Knowledge of community health and social service agencies and additional community resources
• Bilingual (English/Spanish); speaking, reading, writing, interpreting, and explaining documents in Spanish

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Additional Information

• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection is suggested.
• Occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40
• Pay Range: $65,000 - $88,600 per year, eligible for a bonus incentive plan based on company and/or individual performance.