Utilization Management Behavioral Health RN, CCR

Humana; Kentucky; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading healthcare company as a Utilization Management Behavioral Health RN. This remote role requires a licensed RN with experience in Behavioral Health Nursing. You'll support care coordination, utilizing your clinical skills and critical thinking. Enjoy a competitive salary and comprehensive benefits while working from home.

Benefits

Comprehensive benefits

Internet expense reimbursement for specific states

Potential bonuses based on performance

Qualifications

• Minimum one year of experience in Behavioral Health Nursing.
• Licensed Registered Nurse (RN) in an enhanced compact (eNLC).

Responsibilities

• Utilizes clinical nursing skills for medical services coordination.
• Applies clinical knowledge to interpret criteria and provide care.

Skills

Behavioral Health Nursing

Communication

Critical Thinking

Teamwork

Education

Bachelor's degree in Nursing

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Join to apply for the Utilization Management Behavioral Health RN, CCR role at Humana.

Get AI-powered advice on this job and more exclusive features.

This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$71,100.00/yr - $97,800.00/yr

Become a part of our caring community and help us put health first

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The work assignments are varied and often require interpretation and independent decision-making.

The Utilization Management Nurse 2 applies clinical knowledge, communication skills, and critical thinking to interpret criteria, policies, and procedures to provide appropriate treatment, care, or services. Coordinates with providers, members, and other parties to facilitate optimal care. Understands departmental, segment, and organizational strategies and objectives, including their linkages. Makes decisions regarding work methods, sometimes in ambiguous situations, with minimal guidance and following established guidelines.

Required Qualifications

• 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).
• Experience in physical health clinical settings, preferably in acute care, obstetrics, skilled nursing, or rehabilitation.
• Proficiency in Microsoft Word, Outlook, and Excel.
• Ability to work independently and as part of a team.

Preferred Qualifications

• Bachelor's degree in Nursing (BSN) or related field.
• Three (3) years of Behavioral Health Nursing experience.
• One (1) year of Medical Surgery, Cardiac, Pulmonary, or Critical Care Nursing experience.
• Previous utilization management experience with ASAM knowledge.
• Experience with health plans, Medicare/Medicaid, bilingual skills are a plus.

Workstyle and Location

Remote work at home, must reside in a state participating in the enhanced nurse licensure compact (eNLC).

Schedule

Monday to Friday, 8:00 AM to 5:00 PM Eastern Time.

Additional Information

Internet requirements include minimum speeds of 25 Mbps download and 10 Mbps upload. Employees in California, Illinois, Montana, or South Dakota will receive internet expense reimbursement. Work from a dedicated, interruption-free space to protect member information.

Applicants may be asked to provide their Social Security Number for verification. The interview process may include HireVue virtual interviews. Occasional travel to offices for training or meetings may be required.

Compensation and Benefits

The pay range is $71,100 to $97,800 annually, with potential bonuses based on performance. Humana offers comprehensive benefits supporting health, wellness, and retirement.

About Humana

Humana is dedicated to putting health first, providing insurance and healthcare services to improve quality of life for diverse communities.

Equal Opportunity Statement

Humana is committed to equal employment opportunity and affirmative action, prohibiting discrimination based on protected statuses.