Behavioral Health UM Professional, Medicaid (Tue-Sat)

Humana

5d • $65,000 - $88,600 • Remote

About The Position

The Utilization Management Behavioral Health Professional 2 utilizes 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 towards interpreting criteria, policies, and procedures to provide 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 and receives guidance where needed. Follows established guidelines/procedures.

Requirements

• Bachelor's degree in Nursing or a Master's degree in a behavioral health-related field (Social Work, Counseling, Psychology, or a related discipline) from an accredited college or university.
• 3+ years of post-degree behavioral health clinical experience providing direct patient care
• Active, unrestricted licensure in one of the following disciplines: Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Active Compact License Registered Nurse (RN), or another behavioral health professional license recognized by applicable state regulations.

Nice To Haves

• 1+ year of experience working in a Managed Care and Medicaid environment.
• Experience conducting Behavioral Health Utilization Management (UM) reviews, including medical necessity determinations using clinical guidelines such as MCG, ASAM, and/or InterQual.
• Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual proficiency in English and Spanish, with the ability to speak, read, write, interpret, and explain documents in Spanish.

Responsibilities

• Support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interpret criteria, policies, and procedures 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.
• 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
• dental
• 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

What This Job Offers

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