Utilization Management Behavioral Health Professional

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟢 Junior

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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 coordination, documentation, and communication of medical services and benefit administration determinations • Interpret criteria, policies, and procedures to determine appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Follow established guidelines and procedures • Report to the Behavioral Health Manager and participate in the Behavioral Health UM Team • Work Monday through Friday during scheduled hours, with weekend and on-call rotations and potential overtime • Complete a six-week training process • Occasionally travel to Humana offices for training or meetings

🎯 Requirements

• Master's level clinician with independent licensure in the state of Louisiana, such as LCSW, LPC, LMFT, or LAC • 1+ year of managed care experience • Familiarity with MCG and American Society of Addiction Medicine Criteria • Proficiency using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) • Strong keyboard and web navigation skills • Ability to provide clear narrative documentation • Exceptional communication and interpersonal abilities • Must be available for a 40-hour work week, Monday–Friday, 8:00 AM–5:00 PM CST • Must cover weekend and on-call rotations as needed • Must reside in Louisiana and perform work within the state • Preferred: 2 years of direct care experience in an acute or outpatient behavioral health setting • Preferred: Experience with Utilization Management or Prior Authorization • Preferred: Experience with behavioral change, health promotion, coaching, and wellness • Preferred: Experience serving Medicare, Medicaid, TANF, and/or CHIP populations • Knowledge of community health and social service agencies and additional community resources • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Must work from a dedicated space protecting member PHI/HIPAA information • Separation of two or more years from LDH is required for covered current or former LDH officials or employees

🏖️ 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 and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Six-week training process • Remote work arrangement • Occasional travel to Humana offices for training or meetings may be required