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Humana Utilization Management Behavioral Health Professional 2 - Registered Nurse in Springfield, Missouri

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

Location: Work at home in any location but must be in a Compact state

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

  • 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 one (1) year of utilization management experience or knowledge of the UM process

  • Proficiency with Microsoft Office products

  • Proficient working with computers

Desired 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

Additional Information

Humana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

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