Utilization Management Behavioral Health Professional

About the role

Become a part of our caring community Humana Healthy Horizons in Kentucky is looking for a Utilization Management Behavioral Health Professional 2.

Responsibilities

• Uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interprets and independently determines the appropriate courses of action based on clinical knowledge, communication skills, and critical thinking skills.
• Collaborates 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.
• Fulfills established guidelines and procedures.

Requirements

• Must reside in the state of Kentucky or a contiguous county in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia.
• Has a Bachelor's degree in Nursing OR a Master's degree in a Human Services field with a professional individual or compact licensure in Kentucky without disciplinary action (e.g., LCSW, LMFT, LPC, PhD, RN).
• Has three (3) or more years of post-degree clinical experience in private practice or other healthcare settings.
• Has intermediate working knowledge using Microsoft Office programs such as Teams, Excel, PowerPoint, Outlook, and Word.

Preferred Qualifications

• 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.

Additional Information

• This is a remote position.
• Workdays & Hours: Monday - Friday; 8:30 AM - 5:00 PM Eastern Standard Time (EST).
• Occasional travel to Humana's offices for training or meetings may be required.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Minimum recommended internet speed of 25 Mbps download and 10 Mbps upload is required.

Workstyle

To ensure effective work from home, the self-provided internet service must meet the minimum criteria of 25 Mbps download and 10 Mbps upload.

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About Us

About Humana: 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 – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.