Utilization Management Behavioral Health Professional

Humana • Louisiana, MO

18d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community and help us put health first The Utilization Management Behavioral Health Professional utilizes 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. This position will report to the Manager Care Management and be part of the Behavioral Health CM Team. In this role you will: •Apply 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 Use your skills to make an impact

Requirements

• Master's level clinician with independent licensure in the state of Louisiana (i.e. Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapists (LMFTs) Licensed Addiction Counselors (LACs)
• 1+ year of managed care experience
• Experience utilizing MCG and American Society of Addiction Medicine Criteria
• Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members.
• Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities.
• Must be available to work 40-hour work week Monday – Friday 8:00-5:00 PM CST, potential for overtime with an expectation to cover a weekend and on-call rotation to meet business needs
• Must reside in Louisiana and perform work within the state
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• 2 years of direct care experience in an acute or outpatient behavioral health setting
• Experience with Utilization Management or Prior Authorization
• Experience with behavioral change, health promotion, coaching and wellness
• Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.
• Knowledge of community health and social service agencies and additional community resources
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Responsibilities

• Apply 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