Company Description

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.

Job Description

The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services. Enjoy the flexibility of Work-At-Home for a company that values your personal well-being. Humana offers a full array of competitive benefits and professional growth opportunities, in addition to unique offerings such as early access to pay and various wellness programs designed to help you live your best life. To be considered, you must have an active compact (Multistate) license and experience in Behavioral Health. #LI-Remote This is a Full-Time, Remote Telephonic RN opportunity, however must be located and licensed in a Compact State 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.

Requirements

Required Qualifications Minimum of Associate Degree in Nursing Registered Nurse (R.N.) licensure with no disciplinary action. Registered nurse with Compact Licensure (licensed and located in compact state) Minimum of three (3) years of post-degree clinical experience in direct patient care with adult population Must have experience in a Behavioral Health setting. Proficiency with Microsoft Office products: Outlook, Word & Excel Adept at working via a computer: on multiple screens, in multiple platforms, and comfortable learning new programs. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Desired Qualifications Bachelor's or advance degree Experience in Behavioral Health, Utilization Management and/or Behavioral Health utilization management experience (performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.) Use of EMR systems Additional Non-compact nursing licenses Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 Associates 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 associates 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

Responsibilities

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 Our department is available Monday – Friday from 7:00 AM-6:30 PM CST. Individual shift will be assigned within these hours.​ What it takes to be successful in this role: Willingness to work Monday to Friday, 8am – 4:30pm Central Standard Time (CST) Flexible and able to adapt to an ever-changing environment. Strong attention to detail.

Help & Resources

Apply Now