Licensed Behavioral Health UM (RN, SW, Counseling, Psychology)

Humana•Louisiana, MO

5d•$65,000 - $88,600•Remote

About The Position

The Licensed Behavioral Health Utilization Management Professional 2 uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The work is varied and frequently requires interpretation and independent determination of appropriate courses of action. This remote position requires residence in Louisiana. The professional applies clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures and support appropriate treatment, care, or services for members. The role coordinates and communicates with providers, members, and other parties to facilitate optimal care and treatment. It requires understanding department, segment, and organizational strategy and operating objectives and their relationship to related areas, making decisions about work methods with minimal direction, and following established guidelines and procedures. The schedule is Monday through Friday, 8:00 AM–5:00 PM Central Time, with flexibility to accommodate an Eastern Time schedule and occasional weekends and holidays. The position is remote, with occasional travel to Humana offices for training or meetings potentially required. Employees must have an internet connection with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. The role is scheduled for 40 hours per week. The estimated starting base-pay range is $65,000–$88,600 per year. The position is eligible for a bonus incentive plan based on company and/or individual performance. Humana offers medical, dental, and vision benefits; a 401(k) retirement savings plan; paid time off and company and personal holidays; paid parental and caregiver leave; short- and long-term disability; life insurance; and other benefits.

Requirements

Meet one of the following licensure requirements with no history of disciplinary action: a Registered Nurse (RN) license under the Multi-State Compact; or a master's degree in a behavioral health-related field (Social Work, Counseling, or Psychology) and a professional license from Louisiana. An additional independent Kentucky license is required.
Behavioral health-related license options listed: Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Addiction Counselor (LAC), or 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.
Must reside in Louisiana.
Ability to meet the work-at-home internet requirements: minimum 25 Mbps download and 10 Mbps upload speeds.
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Behavioral Health Utilization Management experience, including medical necessity reviews using criteria such as MCG, ASAM, or InterQual.
Managed Care or Medicaid experience.
Health plan experience.

Responsibilities

Support coordination, documentation, and communication of medical services and benefit administration determinations.
Interpret clinical criteria, policies, and procedures to help determine appropriate treatment, care, or services for members.
Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
Understand department, segment, and organizational strategies and operating objectives and their connections to related areas.
Make decisions regarding work methods, including in occasionally ambiguous situations, while following established guidelines and procedures.