Utilization Management Behavioral Health Professional

Humana • Work at Home - Virginia, SC

2d • $65,000 - $88,600 • Remote

About The Position

The Utilization Management Behavioral Health Professional 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 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.

Requirements

• Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings)
• Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia
• Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting
• Minimum one, (1) year of managed care experience
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills

Nice To Haves

• 1+ years of 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

• 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.
• 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, volunteer time off, 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
• Education Level: No Education Listed