Utilization Management Behavioral Health RN, CCR

Humana; Orlando (FL); 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 using clinical nursing skills to coordinate and document medical services while ensuring members receive optimal care. The ideal candidate will be a licensed RN with experience in Behavioral Health Nursing and strong communication skills. This position offers remote work flexibility and a supportive environment focused on health and well-being.

Qualifications

• Minimum one year of experience in Behavioral Health Nursing.
• Proficiency in Microsoft Office tools.

Responsibilities

• Utilizes clinical nursing skills for medical services coordination.
• Applies clinical knowledge to ensure appropriate treatment.

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

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 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. They coordinate with providers, members, and other parties to facilitate optimal care. They understand departmental and organizational strategies, make decisions with minimal guidance, and follow established procedures.

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.
• Experience in utilization management with ASAM knowledge.
• Health Plan experience.
• Medicare/Medicaid experience is a plus.
• Bilingual skills are a plus.

Work Details

Remote work from home, residing in a state participating in the enhanced nurse licensure (eNLC).

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

Additional info includes internet requirements, occasional travel, and use of HireVue for interviews.