Manager, Utilization Management Behavioral Health Nursing

Humana

2d • Remote

About The Position

Become a part of our caring community The Manager, Utilization Management Behavioral Health Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health Nursing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Utilization Management Behavioral Health Nursing 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, andconducts briefings and area meetings; maintains frequent contact with other managers across the department. Use your skills to make an impact

Requirements

• Must reside in the state of Oklahoma
• Registered Nurse or LPC or LMFT or LMSW is required
• Minimum 2 years of Utilization Management or case management experience
• Previous Leadership or management experience, to include leading people/teams in UM practices

Nice To Haves

• Advanced degree in nursing, healthcare, or business
• CMS criteria

Responsibilities

• Utilizes clinical nursing skills to support the coordination, documentation and communication of behavioral health services and/or benefit administration determinations.
• Works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
• 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.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration, andconducts briefings and area meetings; maintains frequent contact with other managers across the department.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees