Remote Behavioral Health Utilization Specialist

Humana; Austin (TX); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana is seeking a Licensed Behavioral Health Utilization Management Professional to coordinate, document, and communicate medical services and benefit determinations for members. This remote role requires clinical judgment, strong communication, and independent problem-solving within guidelines.

The successful candidate will have 3+ years of behavioral health experience, valid licensure (RN or behavioral health license), and proficiency with MS Office and multiple systems in a remote work

Qualifications

• 3+ years of post-degree clinical experience in direct patient care.
• 3+ years of Behavioral Health experience.
• Proficient with MS Office and navigating multiple systems; remote work capability.
• One of the required licenses (RN, LCSW, LMSW, LPC, LMFT, LAC, or Psychologist).

Responsibilities

• Coordinate and communicate with providers and members to facilitate care.
• Interpret criteria, policies, and procedures to determine appropriate actions.
• Support documentation and communication of medical services and benefit determinations.
• Work remotely with minimal supervision after training.

Skills

Clinical experience (post-degree)

Behavioral health experience

MS Office proficiency

Remote work skills

Communication skills

Independent critical thinking

Education

RN – Multi-State Compact

Master's degree in behavioral health field with state license (LA)

Licensed Clinical Social Worker (LCSW)

Licensed Master Social Worker (LMSW)

Licensed Professional Counselor (LPC)

Licensed Marriage and Family Therapist (LMFT)

Licensed Addiction Counselor (LAC)

Licensed Psychologist

Tools

MS Office

Job description

Humana is seeking a Licensed Behavioral Health Utilization Management Professional to coordinate, document, and communicate medical services and benefit determinations for members. This remote role requires clinical judgment, strong communication, and independent problem-solving within guidelines.

The successful candidate will have 3+ years of behavioral health experience, valid licensure (RN or behavioral health license), and proficiency with MS Office and multiple systems in a remote work