Utilization Management Behavioral Health Professional

Become a part of our caring community. 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. This position will report to the Manager Care Management and be part of the Behavioral Health CM Team.

About the role

Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

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.
• 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 and procedures.

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 a 40-hour work week Monday–Friday 8:00 AM–5:00 PM CST, with potential for overtime and an expectation to cover a weekend and on-call rotation to meet business needs.
• Must reside in Louisiana and perform work within the state.

Preferred Qualifications

• 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.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable, or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Pay

The pay range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications.

$65,000 - $88,600 per year.

This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

• Medical, dental, and 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.

About Us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health by delivering the care and service they need, when they need it.