[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. The 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, with minimal direction.
• Follows established guidelines/procedures.

Qualifications

• Must meet one of the following:
  • 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.
• 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 (preferred).
• Experience with behavioral change, health promotion, coaching, and wellness (preferred).
• Knowledge of community health and social service agencies and additional community resources (preferred).

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities.

Additional Information

• Workstyle: Remote work at Home.
• Schedule: Must work a minimum of 8 hours between 8:00 AM to 5:00 PM Eastern Time; may be required to work rotating holidays or weekends as determined by business needs.
• Travel: Less than 5% to attend onsite market meetings as business needs.
• Interview Format: Using an interviewing technology called HireVue.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Scheduled Weekly Hours: 40.
• Pay Range: $65,000 - $88,600 per year; eligible for a bonus incentive plan based on performance.