Licensed Behavioral Health UM, Tuesday-Saturday (RN, SW, Counseling, Psychology)

Humana • Louisiana, MO

6d • $65,000 - $88,600 • Remote

About The Position

The Licensed Behavioral Health Utilization Management Professional uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Licensed Behavioral Health Utilization Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Licensed Behavioral Health Utilization Management Professional 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

• Licensed Registered Nurse (RN) – Multi-State Compact OR Master's degree in a behavioral health–related field (Social Work, Counseling, Psychology) with a professional license from the state of Louisiana.
• Licensed Clinical Social Worker (LCSW)
• Licensed Master Social Worker (LMSW)
• Licensed Professional Counselor (LPC)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Addiction Counselor (LAC)
• Licensed Psychologist
• No history of disciplinary action.
• 3+ years of post-degree clinical experience in direct patient care.
• 3+ years of Behavioral Health experience.
• Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.

Nice To Haves

• An additional independent Kentucky license.
• Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual.
• Managed Care, Medicaid.
• Health plan experience.

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 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

What This Job Offers

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