[Remote] Utilization Management Behavioral Health Professional

Note: The job is a remote job and is open to candidates in USA. Humana is committed to putting health first and is seeking a Utilization Management Behavioral Health Professional to support the coordination, documentation, and communication of medical services. This role requires clinical knowledge and skills to facilitate optimal care and treatment for members, while making independent decisions in varied situations.

Responsibilities

• 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

Skills

• 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
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
• Ability to use a variety of electronic information applications/software programs including electronic medical records
• 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
• 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

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

Company Overview

Company H1B Sponsorship