Remote Utilization Review Rn Jobs in Oregon (NOW HIRING)

Become a part of our caring community
Humana Healthy Horizons is looking for a Utilization Management Behavioral Health Professional 2 who uses behavioral health knowledge to support the coordination, documentation, and communication of medical services 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.
You will be part of a caring community at Humana.
When you meet us, you can tell we started as a hometown company. We're proud of our Louisville roots and, as we've grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are-whether you're working from home, from the field, from our offices, or from somewhere in between-you'll feel welcome here. We're a caring community that makes close-knit teams, forges cross-country friendships, and forms inclusive resource groups, all gathering around one big table where we hear and respect everyone's voice. Community is a verb here. It's up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.
Are you Caring, Curious and Committed? If so, apply today!

The Utilization Management Behavioral Health Professional 2

• Use clinical knowledge, towards interpreting criteria and procedures to provide the best treatment, care or services for members
• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed
• Follow established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree from an accredited institution.
• 1+ year of post-degree clinical experience in a private practice or patient care setting
• Active, unrestricted licensure in one of the following disciplines:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Masters Social Worker (LMSW-ACP)
  • Licensed Professional Counselor (LPC)
  • Registered Nurse (RN)
  • Or another behavioral health professional license recognized by applicable state regulations.

Preferred Qualifications

• Master's degree from an accredited institution.
• 1+ year of experience working in a managed care environment.
• Experience utilizing ASAM, MCG, or InterQual clinical guidelines.
• Demonstrated subject matter expertise in utilization review for inpatient and outpatient behavioral health services.
• Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual proficiency in English and Spanish, with the ability to speak, read, write, interpret, and explain documents in Spanish (See additional information under the Language Assessment Statement)

Additional Information

• Schedule/Time Zone: Monday through Friday, 8:00 AM - 5:00 PM with flexibility to work overtime/weekendsas needed.
• Work Location: US
• Work Style: Remote

Work-at-Home (WAH)Internet Statement: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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

Language Assessment Statement: Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.Application Deadline: 06-12-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.