Job Details

Utilization Management Behavioral Health Professional 2-Remote Opportunity

Company name
Humana Inc.

Location
Newport, RI, United States

Employment Type
Full-Time

Industry
Healthcare, Nursing, Bilingual

Posted on
May 06, 2022

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Profile

Description

The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Behavioral Health Professional 2 - Registered Nurse completes telephonic reviews with the Utilization Reviewer at the Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.

Complete telephonic, faxed, and voicemail reviews with facilities

Assess discharge plans

Coordinated with Care Coordination and Case Management

Discuss cases with Medical Directors in daily rounds

Complete documentation for Quality Reviews for Peer Reviews

Department hours are 8-7:30 p.m. EST, shifts are based on business need and can change at any time

Required Qualifications

Associates Degree in Nursing

Must be licensed in a Compact State

Registered Nurse (RN)

Minimum of five (5) years of post-degree clinical experience in direct patient care

Three (3) years or more of Behavioral Health experience

Minimum of three (1) year of utilization management experience or knowledge of the UM process

Proficiency with Microsoft Office products

Proficient working with computers

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Experience with utilization review process

Knowledge of community health and social service agencies and additional community resources

Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Prefer CA or AZ nursing license (must obtain license within 6 months of hire.)

Additional Information

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com

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