Utilization Management Behavioral Health RN, CCR

Humana; Oklahoma; 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 will coordinate care, communicate with providers, and ensure members receive optimal services. Enjoy a competitive salary and comprehensive benefits while working from home.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• Licensed RN in an eNLC state with no disciplinary action.
• Minimum one year of experience in Behavioral Health Nursing.

Responsibilities

• Utilizes clinical nursing skills for coordination and communication of medical services.
• Applies clinical knowledge to interpret criteria and ensure appropriate treatment.

Skills

Behavioral Health Nursing

Clinical Knowledge

Communication Skills

Critical Thinking

Teamwork

Education

BSN or bachelor's degree in a related field

Tools

Microsoft Word

Outlook

Excel

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, ensuring members receive appropriate treatment, care, or services. Coordinates and communicates with providers, members, and other parties to facilitate optimal care. Understands department, segment, and organizational strategies and 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 action.
• 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 and in a team environment.

Preferred Qualifications

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

Work Details

Workstyle: Remote work from home.

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

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

Additional Information

Internet requirements include a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Satellite, cellular, or microwave connections require leadership approval. Employees in California, Illinois, Montana, or South Dakota will receive internet expense reimbursement.

Applicants may be asked to provide their Social Security Number for verification. The interview process includes using HireVue technology. Occasional travel to Humana offices may be required.

Scheduled Weekly Hours: 40

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

Benefits

Humana offers competitive benefits supporting overall well-being, including medical, dental, vision, 401(k), paid time off, disability insurance, life insurance, and more.

About Us

Humana Inc. is dedicated to putting health first, providing services that help people achieve their best health and improve quality of life across various communities.

Equal Opportunity Employer

Humana values diversity and is committed to equal employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status. We also promote affirmative action to support individuals with disabilities and protected veterans.