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About the Role
Utilize behavioral health knowledge to support the coordination, documentation, and communication of medical services or benefit administration determinations. This role involves varied assignments that require interpretation and independent determination of appropriate courses of action within a caring community.
Responsibilities
- Use clinical knowledge to interpret criteria and procedures for optimal 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.
- Make decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.
- Follow established guidelines and procedures.
Requirements
- 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.
Skills
- Behavioral health knowledge
- Coordination
- Documentation
- Communication
- Clinical knowledge
- Interpreting criteria and procedures
- Working in a managed care environment
- Utilizing ASAM, MCG, or InterQual clinical guidelines
- Utilization review for inpatient and outpatient behavioral health services
- Behavioral change methodologies
- Health promotion
- Coaching
- Wellness initiatives
- Bilingual proficiency in English and Spanish
Location
- US
Work Type
- Remote
- Work-at-Home (WAH)
Experience Level
- 1+ year of post-degree clinical experience
- 1+ year of experience working in a managed care environment
Education Level
- Bachelor's degree
- Master's degree
Salary/Compensations
- $65,000 - $88,600 per year
Benefits
- Medical benefits
- Dental benefits
- 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 disability
- Long-term disability
- Life insurance
About the Company
- 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 at Humana.com and at CenterWell.com.
Equal Opportunity
- 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, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.