Utilization Management Behavioral Health Professional

🔥 5 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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/or benefit administration determinations • Interpret criteria, policies, and procedures to provide appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Understand department, segment, and organizational strategy and operating objectives • Make decisions regarding work methods, including in ambiguous situations, with minimal direction • Follow established guidelines and procedures • Attend the Annual All Hands meeting once per year, typically in spring • Occasionally travel to Humana offices for training or meetings

🎯 Requirements

• Bachelor’s degree in nursing OR a master's degree in a Human Services field • Professional individual or compact licensure in the state of Kentucky without disciplinary action, such as LCSW, LMFT, LPC, Psychologist (PhD), RN, or another professional license • Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings • Intermediate working knowledge of Microsoft Office Programs, specifically Excel, PowerPoint, Outlook and Word • Ability to use systems and platforms and troubleshoot and resolve general technical difficulties • Exceptional oral and written communication and interpersonal skills • Ability to build rapport with internal and external customers and stakeholders • Experience working within a managed care organization or a health plan (preferred) • Experience with utilization review process (preferred) • Experience with behavioral change, health promotion, coaching and wellness (preferred) • Experience working with individuals with substance use diagnoses (preferred) • Knowledge of community health and social service agencies and additional community resources (preferred) • Knowledge of substance use disorders and recovery process (preferred) • Ability to work Monday–Friday, 8:30 AM–5:00 PM Eastern Time • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental and caregiver leave • Short-term disability • Long-term disability • Life insurance • Annual All Hands meeting travel • Remote work arrangement • Self-provided internet requirements and dedicated workspace support for home working

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