[Hiring] Utilization Management Behavioral Health Professional @Humana

Role Description

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. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures.
• Provides 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.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Follows established guidelines/procedures.

Qualifications

• Must meet one of the following:
  • Active unrestricted registered nurse license in the state of Virginia 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 within the state of Virginia.
• Must meet all of the following:
  • 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.

Requirements

• 1+ years of experience with utilization review process.
• Experience with behavioral change, health promotion, coaching, and wellness.
• Knowledge of community health and social service agencies and additional community resources.

Benefits

• 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.
• Many other opportunities.

Company Description

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.