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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Behavioral Health Utilization Management and Medical Necessity Reviews, with a strong focus on patient care coordination and adherence to established guidelines. Proficient in interpreting policies and procedures while ensuring compliance with HIPAA regulations.
Highest-signal resume keywords
Licensed Registered NurseBehavioral Health ExperienceClinical Experience in Direct Patient CareBehavioral Health Utilization ManagementProficient with MS Office
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health Utilization ManagementMedical Necessity ReviewsClinical ExperiencePatient Care CoordinationPolicy Interpretation
Soft Skills
Independent Decision-MakingEffective CommunicationProblem-Solving
Tools & Technologies
MS OfficeRemote Work Platforms
Certifications & Qualifications
Registered Nurse License in IndianaCompact Nursing License
Industry Keywords
MCGASAMInterQualHIPAA CompliancePatient Health Information (PHI)
About the role
Key responsibilities & impact- Support coordination, documentation, and communication of medical services and/or benefit administration determinations
- Interpret criteria, policies, and procedures using behavioral health knowledge
- Provide appropriate treatment, care, or services for members
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Make independent determinations regarding appropriate courses of action
- Follow established guidelines and procedures
- Perform behavioral health utilization management and medical necessity reviews against criteria such as MCG, ASAM, and InterQual
- Work remotely from home and occasionally travel to Humana offices for training or meetings
Requirements
What you’ll need- Degree in Nursing
- Must be licensed Registered Nurse in the State of Indiana or Compact Nursing License with no disciplinary action
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office
- Ability to navigate multiple systems and platforms
- General technical skills to troubleshoot and resolve issues within a remote environment
- Ability to work independently
- Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information
- Home internet with at least 25 Mbps download speed and 10 Mbps upload speed
- Ability to work Monday through Friday, 8:00 AM–5:00 PM Eastern Time
Benefits
Comp & perks- Bonus incentive plan based upon company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Occasional travel to Humana offices for training or meetings