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

• Apply behavioral health knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures • Determine appropriate treatment, care, or services for members • Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment • Support coordination, documentation, and communication of medical services and benefit administration determinations • Follow established guidelines and procedures • Document, communicate, and collaborate using electronic information systems and Microsoft Office tools • Provide clear narrative documentation and build rapport with members and internal partners • Cover a weekend and on-call rotation as needed to meet business needs

🎯 Requirements

• Master's level clinician with independent licensure in Louisiana, such as LCSW, LPC, LMFT, or LAC • 1+ year of managed care experience • Experience utilizing MCG and American Society of Addiction Medicine Criteria • Proficiency with electronic information systems and Microsoft Office tools, including Word, Outlook, and Excel • Strong keyboard and web navigation skills • Ability to provide clear narrative documentation • Exceptional communication and interpersonal abilities • Availability for a 40-hour work week, Monday–Friday, 8:00 AM–5:00 PM CST • Must reside in Louisiana and perform work within the state • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • 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 • Preferred: Knowledge of community health and social service agencies and additional community resources • Preferred: Bilingual English/Spanish ability

🏖️ Benefits

• Bonus incentive plan • 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 • Home-based work arrangement • Potential for overtime • Occasional travel to Humana offices for training or meetings