Utilization Management Behavioral Health Professional

About the role

The Utilization Management Behavioral Health Professional supports the coordination, documentation, and communication of medical services and/or benefit administration determinations. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

• Supports the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interprets criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
• Collaborates with providers, members, or other parties to facilitate optimal care and treatment.
• Works independently under general instructions and with a team.
• 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.
• One (1) year of post-degree clinical experience in private practice or other clinical patient care setting.
• 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.

Qualifications

• 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.

Skills

• Utilization review process experience.
• Behavioral change, health promotion, coaching and wellness knowledge.
• Community health and social service agencies and additional community resources understanding.

Benefits

Includes 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.

Pay

$65,000 - $88,600 per year

Schedule

Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs.

Additional Information

Workstyle: Remote work at Home
Schedule: Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs
Travel: Less than 5% to attend onsite market meetings as business needs
Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work from Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.

Workplace

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.