RN - UM Behavioral Health Professional 2
Humana

Tampa, Florida

Posted in Insurance


This job has expired.

Job Info


Description

Job Summary
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

The Utilization Management Behavioral Health Professional 2 completes telephonic and/or electronic 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. This individual will utilize behavioral health knowledge and skills to work with identified members to assess their care needs, assist in planning and implementing interventions to meet those needs, assist in coordinating services, and monitoring and evaluating the case management plan against the member's personal health care goals. In this role, you will:

  • Complete telephonic reviews with facilities
  • Assess discharge plans
  • Coordinated with Care Coordination and Case Management
  • Discuss cases with Medical Directors
  • Complete documentation for Quality Reviews for Peer Reviews
  • Communicate with members that were recently discharged from facility based care
  • Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
  • Assist members in achieving stability and improved well-being in their community
  • Facilitate wrap-around planning for members who have had recent inpatient utilization
  • Understand clinical program design, implementation, and management, monitoring and reporting
  • Work collaboratively 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
  • Hours: 8 hour shifts to meet business need 7:30-6:30 CST
Required Qualifications

  • Degree in Nursing
  • RN license
  • Compact state RN license
  • Minimum of three (3) years of clinical experience
  • Three (3) years or more of Behavioral Health experience
  • Proficiency with Microsoft Office products
  • Experience working with computers
Preferred Qualifications

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

Working in the state of Arizona must comply with the Tobacco Free Hiring Policy and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Interview Format:
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

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 Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40


This job has expired.

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