Utilization Management Behavioral Health Professional

Humana

3d•$65,000 - $88,600•Remote

About The Position

Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 to use behavioral health knowledge and skills in coordinating, documenting, and communicating medical services and benefit administration determinations. Assignments are varied and often require interpreting information and independently determining appropriate courses of action. The role applies clinical knowledge, communication skills, and independent critical thinking 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 strategy and operating objectives, making decisions about work methods with minimal direction, and following established guidelines and procedures.

Requirements

Bachelor’s degree in nursing, or a master’s degree in a Human Services field with a professional individual or compact license in Kentucky and no disciplinary action. Listed licenses include LCSW, LMFT, LPC, PhD Psychologist, RN, or another professional license.
At least three years of post-degree clinical experience in private practice or other healthcare settings.
Intermediate working knowledge of Microsoft Office programs, specifically Excel, PowerPoint, Outlook, and Word, and the ability to troubleshoot and resolve general technical difficulties.
Exceptional oral and written communication and interpersonal skills, with the ability to build rapport with internal and external customers and stakeholders.

Nice To Haves

Experience working within a managed care organization or health plan.
Experience with the utilization review process.
Experience with behavioral change, health promotion, coaching, and wellness.
Experience working with individuals with substance use diagnoses.
Knowledge of community health and social service agencies and additional community resources.
Knowledge of substance use disorders and the recovery process.

Responsibilities

Use clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures and support 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 strategy and operating objectives and their links to related areas.
Make decisions regarding work methods, including occasionally in ambiguous situations, with minimal direction and guidance as needed.
Follow established guidelines and procedures.