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Utilization Management Behavioral Health Nurse 2-Remote Position

Company: Humana
Location: Green Bay
Posted on: May 16, 2022

Job 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.


The Utilization Management Behavioral Health Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Nursing license is required. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

**Required Qualifications**

**NOTE:** Our department is available Monday - Friday from 7-6:30pm CST. Hours for this role are based on business need between that timeframe.

+ **Minimum of Associate'ss Degree in Nursing**

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

+ **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**

+ **One (1) year of managed care experience**

+ **Proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote**

+ **Adept experience working with computers**

**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**

+ BSN degree

+ Master's degree in nursing

+ Use of EMR systems

+ Additional Non-compact nursing licenses

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

**Additional Information**

**Interview Process**

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 correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. 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 or computer 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.

**Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from with instructions to add the information into the application at Humana's secure website**

_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. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire._

**Scheduled Weekly Hours**


Keywords: Humana, Green Bay , Utilization Management Behavioral Health Nurse 2-Remote Position, Healthcare , Green Bay, Wisconsin

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