Utilization Management Behavioral Health RN, CCR

Santa Barbara Cottage Hospital; Montana; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a leading healthcare organization as a Utilization Management Nurse 2, where you will apply your nursing skills to ensure optimal care for members. This remote role requires strong clinical knowledge and communication skills, with responsibilities including coordination of medical services and benefit administration. You will work collaboratively with a diverse team while making independent decisions to enhance patient care. Competitive salary and benefits are offered.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

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

Responsibilities

• Utilizes clinical nursing skills to support coordination of medical services.
• Coordinates and communicates with providers and members for optimal care.

Skills

Communication

Critical Thinking

Independence

Education

Bachelor's degree in Nursing

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

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 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, ensuring the delivery of appropriate treatment, care, or services for members. They coordinate and communicate with providers, members, and other parties to facilitate optimal care. They understand organizational strategies and objectives, making decisions with minimal guidance and following established guidelines.

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) in an enhanced compact (eNLC) with no disciplinary action.
• At least one year of experience in Behavioral Health Nursing (inpatient, outpatient, psych, substance use).
• Clinical experience in physical health, preferably in acute care, obstetrics, skilled, or rehabilitation settings.
• Proficiency in Microsoft Word, Outlook, and Excel.
• Ability to work independently with general instructions and collaboratively with a team.

Preferred Qualifications

• Bachelor's degree in Nursing (BSN) or related field.
• Three years of Behavioral Health Nursing experience.
• One year of Medical Surgery, Cardiology, or Critical Care Nursing experience.
• Experience in utilization management with ASAM knowledge.
• Experience with health plans, Medicare, or Medicaid is a plus.
• Bilingual abilities are a plus.

Workstyle: Remote work from home.

Location: Must reside in a state participating in the enhanced nurse licensure compact (eNLC).

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

Additional Information

Work at Home Guidance: Internet service must meet minimum speed requirements (25 Mbps download, 10 Mbps upload). Wireless, wired cable, or DSL connections are recommended. Satellite, cellular, or microwave connections require approval. Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense stipend. A dedicated workspace is required to protect member PHI/HIPAA information.

SSN Alert: Applicants may need to provide their Social Security Number via a secure link from [e-mail].

Interview Format: Interviews will be conducted via HireVue, an online video interview platform.

Travel may be required occasionally for training or meetings.

Scheduled Weekly Hours: 40

Pay Range: $71,100 - $97,800 annually, based on location and experience. The role is eligible for a performance-based bonus.

Benefits: Competitive benefits include medical, dental, vision, 401(k), paid time off, disability insurance, life insurance, and more.

About Us

Humana Inc. is dedicated to putting health first through innovative insurance and healthcare services, aiming to improve quality of life for diverse populations.

Equal Opportunity Employer

Humana is committed to a diverse workforce and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, veteran status, or other protected categories. We promote affirmative action and equal employment opportunities across all employment actions.