Utilization Management Behavioral Health Professional

Humana

3d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community The Utilization Management Behavioral Health Professional uses behavioral health knowledge to support the coordination, documentation, and communication of medical services and benefit administration determinations. Reporting to the UMB Manager, the UMB Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health 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 · Occasional travel is required to our corporate office, located in Louisville, Kentucky, based on business need · Work schedule will be 8:30am-5:00 and includes a weekend rotation, with possibility of alternate schedule to include Sat/Sun hours Use your skills to make an impact

Requirements

• 3+ years of post-degree clinical experience in private practice or other healthcare settings
• Must have one of the following active licenses in the state of Kentucky without restriction:
• Registered Nurse
• Licensed Masters Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Professional Counselor (LPC)
• Psychologist (PhD)

Nice To Haves

• Experience with utilization review process
• Experience with behavioral change, health promotion, coaching and wellness
• Knowledge of community health and social service agencies and additional community resources

Responsibilities

• 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

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees