UM Behavioral Health Professional

Humana • Work at Home - Illinois, IL

8d • $65,000 - $88,600 • Remote

About The Position

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 Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills. They use these skills towards interpreting criteria, policies, and procedures. The goal is to provide the best and most appropriate treatment, care, or services for members. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. Understand 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 and receives guidance where needed. Follows established guidelines/procedures.

Requirements

• Applicable State licensure in field of study without disciplinary action (LCSW, LMSW-ACP, LPC, Psychologist (PhD), or other professional license).
• Minimum three (3) years of post-degree clinical experience in private practice or other patient care (e.g., child development, dissociation, hyperactivation, ABA, trauma responses, depression, anxiety, substance use, geriatric care focusing on age-related cognitive function).
• Minimum one (1) year of managed care/health plan experience.

Nice To Haves

• Experience with pre-authorization/utilization review processes.
• Experience with behavioral change, health promotion, coaching and wellness.
• Experience working with pediatric to older adult population.
• Knowledge of community health and social service agencies and additional community resources.
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish.

Responsibilities

• Support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interpret criteria, policies, and procedures.
• Provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follow established guidelines/procedures.

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
• Bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level