Utilization Management Behavioral Health Nurse

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Support coordination, documentation, and communication of medical services and/or benefit administration determinations • Interpret criteria, policies, and procedures using behavioral health knowledge • Provide appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Make independent determinations regarding appropriate courses of action • Follow established guidelines and procedures • Perform behavioral health utilization management and medical necessity reviews against criteria such as MCG, ASAM, and InterQual • Work remotely from home and occasionally travel to Humana offices for training or meetings

🎯 Requirements

• Degree in Nursing • Must be licensed Registered Nurse in the State of Indiana or Compact Nursing License with no disciplinary action • 3+ years of post-degree clinical experience in direct patient care • 3+ years of Behavioral Health experience • Proficient with MS Office • Ability to navigate multiple systems and platforms • General technical skills to troubleshoot and resolve issues within a remote environment • Ability to work independently • Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information • Home internet with at least 25 Mbps download speed and 10 Mbps upload speed • Ability to work Monday through Friday, 8:00 AM–5:00 PM Eastern Time

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Occasional travel to Humana offices for training or meetings

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