Utilization Management Behavioral Health RN, CCR

Humana; North Carolina; Remote; USD 71,000 - 98,000; Full time

Job summary

A leading healthcare company is seeking a Utilization Management Behavioral Health RN to join their team. This role involves utilizing clinical nursing skills to coordinate and communicate medical services, ensuring members receive appropriate care. The ideal candidate will have a valid RN license, experience in Behavioral Health Nursing, and strong communication skills. This position offers a competitive salary and comprehensive benefits, including medical, dental, and 401(k).

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) state.
• Minimum one year of experience in Behavioral Health Nursing.
• Clinical experience in physical health preferred.

Responsibilities

• Utilizes clinical nursing skills to support medical services coordination.
• Applies clinical knowledge and critical thinking for appropriate treatment.
• Coordinates with providers and members for optimal care.

Skills

Clinical nursing skills

Communication skills

Critical thinking

Proficiency in Microsoft Word

Proficiency in Microsoft Outlook

Proficiency in Microsoft Excel

Education

Bachelor's degree in Nursing (BSN) or related field

Job description

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

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 ensure members receive appropriate treatment, care, or services. Coordinates and communicates 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, following established guidelines and procedures.

Required Qualifications

• Licensed Registered Nurse (RN) in an enhanced compact (eNLC) state, with no disciplinary actions.
• Minimum one (1) year of experience in Behavioral Health Nursing (inpatient, outpatient, psych, substance use).
• Clinical experience in physical health, preferably in acute care, obstetrics, skilled nursing, or rehabilitation settings.
• Proficiency in Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and within a team environment.

Preferred Qualifications

• Bachelor's degree in Nursing (BSN) or related field.
• Three (3) years of Behavioral Health Nursing experience.
• One (1) year of Medical Surgical, Cardiology, Pulmonary, or Critical Care Nursing experience.
• Experience in utilization management with ASAM knowledge.
• Health Plan experience.
• Medicare/Medicaid experience is a plus.
• Bilingual abilities are a plus.

Additional Details

Workstyle: Remote work at home.

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

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

Work Environment: Reliable internet connection (minimum 25 Mbps download, 10 Mbps upload), dedicated workspace, and compliance with HIPAA/PHI security protocols.

Other: Occasional travel for training or meetings may be required. The position is full-time (40 hours/week) with a pay range of $71,100 - $97,800 annually. Eligible for performance-based bonuses.

Benefits: Medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

About Humana: Committed to health and well-being through insurance and healthcare services, aiming to improve quality of life for diverse populations.

Equal Opportunity: Humana prohibits discrimination and promotes affirmative action in employment practices.