UM Behavioral Health RN 2 - Remote Louisiana

Profile

Description

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

Responsibilities

The Utilization Management Behavioral Health Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting

The Pre-Authorization Nurse 1 completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes.

Enters and maintains pertinent clinical information in various medical management systems.

Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction.

Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Required Qualifications

Unrestricted Active RN license in the state of Louisiana with the ability to be licensed in multiple states

3 years experience as a Registered Nurse with at least 1 year of clinical experience in a behavioral health setting

1 or more year of Managed Care/Insurance Industry experience

Training: October 10th 2022

Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, over-time may be requested to meet business needs

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field

Work-At-Home 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

Bachelors Degree in Nursing

Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Experience working in Medicaid or Medicare

Proficient utilizing electronic medical record and clinical documentation programs

Experience with behavioral change, health promotion, coaching and wellness

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

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

Psychiatric-Mental Health Certification

Reside in Louisiana

Additional Information

Interview Format

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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) 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 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.

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Scheduled Weekly Hours

40

Company info

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