Utilization Management Behavioral Health Professional

🔥 41 minutes ago

🌴 South Carolina, Tennessee, +2 more states – Remote

🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – 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

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

• Uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. • Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. • Uses 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. • Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

🎯 Requirements

• Must meet one of the following: Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings) • Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia • Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting • Minimum one, (1) year of managed care experience • Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms • Ability to troubleshoot and resolve basic technical difficulties in a remote environment. • Ability to work independently under general instructions and with a team • Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills

🏖️ 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 • Competitive benefits that support whole-person well-being