Utilization Management Behavioral Health Professional

Humana • Work at Home - Kentucky, IN

2d • $65,000 - $88,600 • Remote

About The Position

Humana Healthy Horizons in Kentucky is looking for a Utilization Management Behavioral Health Professional 2 who uses 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. Utilize 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. Follows established guidelines/procedures. Use your skills to make an impact.

Requirements

• Must reside in the state of Kentucky or a county that is contiguous to Kentucky state border in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia.
• Bachelor's degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without disciplinary action. Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license.
• Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings.
• Intermediate working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word, systems and platforms.

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.
• Knowledge and experience working with individuals with substance use diagnoses.
• Knowledge of substance use disorders and recovery process.

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.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• 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