Humana is looking for a Utilization Management Behavioral Health RN to join our team. You will use your clinical nursing skills to coordinate, document, and communicate medical services and benefit administration determinations. This role involves interpreting criteria, policies, and procedures to provide the best and most appropriate treatment for our members while coordinating with providers, members, and other parties.
What You'll Do
- Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
- Use clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures.
- Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
- Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction.
- Follow established guidelines and procedures.
What We're Looking For
- Licensed Registered Nurse (RN) in an enhanced compact, (eNLC) with no disciplinary action.
- Minimum one (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance use).
- Varied physical health clinical experience preferably in an acute care, obstetrics, skilled or rehabilitation clinical setting.
- Comprehensive knowledge of Microsoft Word, Outlook and Excel.
- Ability to work independently under general instructions and with a team.
- Must reside in a state that participates in the enhanced nurse licensure, (ENLC).
Nice to Have
- BSN or Bachelor's degree in a related field.
- 3 years of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance use).
- 1 year of Medical Surgery, Heart, Lung or Critical Care Nursing experience.
- Previous experience in utilization management with ASAM knowledge.
- Health Plan experience.
- Previous Medicare/Medicaid Experience.
- Bilingual.
Technical Stack
- Microsoft Word
- Microsoft Outlook
- Microsoft Excel
Benefits & Compensation
- Compensation: $71,100 - $97,800 per year
- 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
- Bonus incentive plan based upon company and/or individual performance
Work Mode
This is a remote position. You must reside in a state that participates in the enhanced nurse licensure, (ENLC).
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 protected veteran status.
