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Job Details

RN Utilization Management - Behavioral Health

Company name
Humana Inc.

Dover, DE, United States

Employment Type

Healthcare, Nursing, Bilingual

Posted on
May 04, 2023

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Full-Time Remote, Telephonic RN opportunity.

The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services.

Enjoy the flexibility of Work-At-Home, from anywhere in the US, for a company that values your personal well-being. To be considered, you must have an active compact (Multistate) license and at least three (3) years of clinical experience.


This department is available Monday - Friday from 7:00 AM-5:30 PM CST. Hours for this role are based on business need between that time frame. Individual shift to be discussed during the interview.

The Utilization Management Behavioral Health Nurse completes medical record reviews from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Duties include:

Complete medical record reviews

Assess discharge plans

Review and extract information from claims

Complete documentation for Quality Reviews for Peer Reviews

Discuss cases with Medical Directors

Work in partnership with other members of the Humana Interdisciplinary team

Comply with performance and reporting standards as defined by Humana

Complete additional responsibilities as deemed appropriate by Humana leadership

Required Qualifications

Minimum of Associate's Degree in Nursing

Registered nurse with active Compact Licensure and no disciplinary actions

Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)

Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote

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

Advanced nursing degree: BSN or MSN

Behavioral Health direct patient care experience preferred

Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.

1 year of managed care experience working directly with insurance companies

Use of EMR systems

Additional Non-compact nursing licenses

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

Additional Information - How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Scheduled Weekly Hours


Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Company info

Humana Inc.
Website :

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