Humana Looking For RN- Behavioral Health Utilization Management at Louisiana Full Time

Description**

The Utilization Management Behavioral Health Nurse 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities**

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

The Pre-Authorization Nurse 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 25×10 (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

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Job Type: Full-time

Pay: $75,000.00 – $76,960.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Travel reimbursement
• Tuition reimbursement
• Vision insurance

Medical specialties:

Schedule:

Application Question(s):

• MANDATORY- Must reside in Louisiana. Do you live in Louisiana?
• MANDATORY- A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
• MANDATORY- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Experience:

• Utilization review/management: 2 years (Required)
• Clinical Nursing as an RN: 3 years (Required)
• Behavioral Health as an RN: 1 year (Required)
• Managed Care/Insurance Industry: 1 year (Required)

License/Certification:

• RN in the state of Louisiana Louisiana (Required)

Work Location: Remote