H
Utilization Management Behavioral Health Professional
Contract type
Ongoing
Work mode
Remote
Experience
Mid-level · 3+ years
Job description
A remote Utilization Management Behavioral Health Professional 2 role at Humana supporting the coordination, documentation, and communication of medical services and benefit administration determinations using behavioral health knowledge. The position involves interpreting criteria and policies to facilitate optimal care and treatment for members.
At a glance
- Employment
- Full-time · Employee (employment agreement)
- Work mode
- Remote
- Pay
- USD 65,000 – 88,600 / year
- Apply before
- January 28, 2027
What you'll do
- Utilize 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.
- Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed.
- Follow established guidelines/procedures.
What we're looking for
- Bachelor's degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without disciplinary action. Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional l
- Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings.
- Intermediate working knowledge using Microsoft Office Programs specifically Excel, PowerPoint, Outlook and Word, systems, platforms, and an ability to troubleshoot and resolve general technical difficulties.
- Exceptional oral and written, communication, and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
Nice to have
- Experience working within a managed care organization or a health plan.
- Experience with utilization review process.
- Experience with behavioral change, health promotion, coaching and wellness.
- Experience working with individuals with substance use diagnoses.
- Knowledge of community health and social service agencies and additional community resources.
- Knowledge of substance use disorders and recovery process.
Your team
Healthy Horizons in Kentucky
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
- Bonus incentive plan
Apply
About Humana
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through Humana insurance services and 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.
Key facts
- Healthcare
- NYSE: HUM
- Leading U.S. healthcare company
- Serves people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large