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About the Role
The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. This role involves interpreting criteria, policies, and procedures to provide optimal treatment, care, or services for members, and coordinating with providers and other parties. The professional makes decisions regarding their work methods with minimal direction.
Responsibilities
- Support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
- Interpret criteria, policies, and procedures to provide optimal treatment, care, or services for members.
- Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
- Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- Follow established guidelines/procedures.
Requirements
- Active unrestricted registered nurse license or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) with Behavioral Health experience (e.g., Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings).
- Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional.
- Minimum one (1) year of post-degree clinical experience in private practice or other clinical patient care setting.
- Minimum one (1) year of managed care experience.
- Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
- Ability to work independently under general instructions and with a team.
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills.
- Internet service 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.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Skills
- Behavioral health knowledge
- Clinical knowledge
- Communication skills
- Independent critical thinking skills
- Microsoft Office Word
- Microsoft Office Excel
- Microsoft Office PowerPoint
- Troubleshooting technical difficulties
- Interpersonal communication skills
- Problem-solving skills
- Facilitation skills
- Utilization review process
- Behavioral change
- Health promotion
- Coaching
- Wellness
- Community health
- Social service agencies
- Community resources
Location
- Remote
Work Type
- Remote work at Home
- Full-time
Experience Level
- Minimum one (1) year of post-degree clinical experience
- Minimum one (1) year of managed care experience
- 1+ years of experience with utilization review process (preferred)
Education Level
- Registered nurse license
- LCSW
- LPC
- LMFT
- LCP
- Licensed Clinical Psychologist
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, 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.
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, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.