Utilization Management Behavioral Health Nurse

Humana, Inc.; Indiana; Híbrido; USD 78.000 - 108.000; Tempo integral

Benefícios oferecidos por esta vaga

Bonus incentive plan

Remote work

Resumo da vaga

Humana, Inc. is seeking a Behavioral Health Nurse for Utilization Management, coordinating medical services and benefit determinations in a remote-capable role based in Indiana.

You will interpret criteria and policies to support member care, communicate with providers, and document decisions. Requires RN license in Indiana with 3+ years in medical and behavioral health settings, and proficiency in MS Office while working independently.

Qualificações

• Degree in Nursing is required.
• Must be licensed Registered Nurse in the State of Indiana or Compaq Nursing License with no disciplinary action
• Minimum 3+ years of post-degree clinical experience in direct patient care
• Minimum 3+ years of Behavioral Health experience
• Proficient with MS Office and able to troubleshoot across multiple systems in a remote environment

Responsabilidades

• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment.
• Interpret criteria, policies, and procedures to determine appropriate actions.
• Document and communicate medical services and benefit determinations.
• Work independently with minimal direction when needed.

Conhecimentos

Independent work

MS Office

Formação

Nursing degree

Indiana RN license or Compaq Nursing License

Ferramentas

MS Office

Descrição da vaga

Become a part of our caring community 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 Utilization Management Behavioral Health Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide 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 and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact

Required 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.

Preferred Qualifications

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

Workstyle

Remote Work at Home

Location

Indiana

Schedule

Monday through Friday 8:00-5:00 PM Eastern Time

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About us

About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.