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Humana Utilization Management Behavioral Health Professional 2 - Registered Nurse in Indianapolis, Indiana

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 anywhere however must be located and licensed in a Compact State

The Utilization Management Behavioral Health Professional 2 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.

  • 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

  • The hours for this role are Hours are 8-5 CST

Required Qualifications

  • Registered nurse with Compact Licensure (licensed and located in compact state)

  • BSN degree

  • Minimum of three (3) years of post-degree clinical experience in direct patient care

  • Three (3) years or more of Behavioral Health experience

  • Minimum of two (2) years of utilization management experience

  • Proficiency with Microsoft Office products

  • Adept experience working with computers

Desired Qualifications

  • Master's degree in nursing

  • Use of EMR systems

  • 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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