Behavioral Health UM Professional, Medicaid

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Support the coordination, documentation, and communication of medical services and benefit administration determinations • Interpret criteria, policies, and procedures to determine appropriate treatment, care, or services • Apply clinical knowledge, communication skills, and independent critical thinking to support member care • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Make independent decisions regarding work methods and courses of action • Follow established guidelines and procedures • Attend occasional meetings and training at Humana offices if required

🎯 Requirements

• Bachelor's degree in Nursing or Master's degree in a behavioral health-related field from an accredited college or university • 3+ years of post-degree behavioral health clinical experience providing direct patient care • Active, unrestricted licensure as an LCSW, LMSW-ACP, LPC, RN with an active compact license, or another recognized behavioral health professional license • Flexibility to work Tuesday through Saturday, 8:00 AM to 5:00 PM Eastern Time • Ability to work remotely from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Self-provided internet service with at least 25 Mbps download and 10 Mbps upload speed • Preferred: 1+ year of experience in a Managed Care and Medicaid environment • Preferred: Experience conducting Behavioral Health Utilization Management reviews and medical necessity determinations using MCG, ASAM, and/or InterQual • Preferred: Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives • Preferred: Bilingual proficiency in English and Spanish, including speaking, reading, writing, interpreting, and explaining documents in Spanish

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Whole-person well-being and personal wellness support • Remote work arrangement • Less than 5% travel may be required for meetings and training