[Hiring] Utilization Management Behavioral Health Nurse @Humana

Role Description

The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/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.
• Provides the best and most appropriate treatment, care, or services for members.
• 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

• Degree in Nursing
• Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
• 3+ years of post-degree clinical experience in direct patient care
• 3+ years of Behavioral Health experience
• Proficient with MS Office, navigating multiple systems and platforms, and general technical skills to troubleshoot and resolve within a remote environment
• Ability to work independently

Requirements

• Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
• Managed Care, Medicaid or health plan experience

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

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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.