Licensed Behavioral Health UM (RN, SW, Counseling, Psychology)
About The Position
The Licensed Behavioral Health Utilization Management Professional 2 uses behavioral health knowledge and skills to support coordination, documentation, and communication of medical services and benefit administration determinations. Work assignments are varied and frequently require interpretation and independent decisions about appropriate courses of action. The role applies clinical knowledge, communication, and critical-thinking skills to interpret criteria, policies, and procedures and support appropriate treatment, care, or services for members. It coordinates and communicates with providers, members, and other parties to facilitate optimal care and treatment. The position requires understanding department, segment, and organizational strategies and objectives, making decisions about work methods with minimal direction, and following established guidelines and procedures. The position is remote and requires residence in Oklahoma. Occasional travel to Humana offices for training or meetings may be required. Employees must work from a dedicated space that protects member PHI/HIPAA information and meet the stated home internet requirements.
Requirements
- Meet one of the licensure pathways with no history of disciplinary action: a Licensed Registered Nurse (RN) with a Multi-State Compact license; or a master's degree in a behavioral health-related field (Social Work, Counseling, or Psychology) and a professional license from Oklahoma. Listed behavioral-health licenses include LCSW, LMSW, LPC, LMFT, LAC, and Licensed Psychologist.
- At least 3 years of post-degree clinical experience in direct patient care.
- At least 3 years of Behavioral Health experience.
- Proficiency with MS Office, navigating multiple systems and platforms, and general technical skills to troubleshoot and resolve issues in a remote environment.
- Reside in Oklahoma.
- Meet home-work requirements: self-provided internet with at least 25 Mbps download and 10 Mbps upload, and a dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information.
Nice To Haves
- An additional independent Kentucky license is preferred.
- Behavioral Health utilization management experience, including medical necessity reviews against criteria such as MCG, ASAM, or InterQual.
- Managed care or Medicaid experience.
- Health plan experience.
Responsibilities
- Support the coordination, documentation, and communication of medical services and benefit administration determinations.
- Interpret behavioral health criteria, policies, and procedures to support appropriate treatment, care, or services for members.
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
- Make decisions about work methods, including in occasionally ambiguous situations, while following established guidelines and procedures.
- Understand department, segment, and organizational strategies, objectives, and their relationships to related areas.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Bonus incentive plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
