Remote Behavioral Health Utilization Specialist

Humana Inc; Northern (KY); Hybrid; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation and communication of medical services and benefit determinations, with responsibilities that include interpreting criteria and acting with independent clinical judgment.

The role emphasizes collaboration with providers and members, remote work options, and adherence to HIPAA standards while contributing to optimal patient care outcomes across Humana programs.

Qualifications

• State licensure in field of study without disciplinary action.
• LCSW, LMSW-ACP, LPC, Psychologist (PhD) or other professional license required.
• Minimum three years post-degree clinical experience in private practice or patient care.
• Minimum one year of managed care/health plan experience.

Responsibilities

• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Interpret criteria, policies, and procedures to determine appropriate actions.
• Apply clinical knowledge and independent critical thinking to support treatment decisions.

Skills

Licensed clinical social worker

LMSW-ACP

LPC

PhD Psychologist

Managed care experience

Job description

Humana Inc. seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation and communication of medical services and benefit determinations, with responsibilities that include interpreting criteria and acting with independent clinical judgment.

The role emphasizes collaboration with providers and members, remote work options, and adherence to HIPAA standards while contributing to optimal patient care outcomes across Humana programs.