Remote Behavioral Health Utilization Specialist

Humana Inc; United States; Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Licensed Behavioral Health Utilization Management Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations.

The role involves interpreting criteria and policies to ensure appropriate treatment and optimal care for members, often in a remote setting. The position requires current licensure (RN, LMSW, LCSW, LPC, LMFT, LAC, or Psychologist) with several years of post-degree clinical and behavioral health

Qualifications

• Must have an active clinical license as required by the licensure options listed.
• Candidates must meet licensure requirements with no history of disciplinary action.

Responsibilities

• Coordinate, document, and communicate medical services and/or benefit determinations.
• Interpret criteria, policies, and procedures to provide appropriate care.
• Communicate with providers, members, and other parties to facilitate optimal care.
• Follow established guidelines and procedures; exercise independent judgment when needed.

Skills

Clinical experience

Behavioral health experience

Independent critical thinking

Remote work troubleshooting

Education

RN - Multi-State Compact

Master's degree in behavioral health

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

Access to multiple health systems

Job description

Humana Inc. is seeking a Licensed Behavioral Health Utilization Management Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations.

The role involves interpreting criteria and policies to ensure appropriate treatment and optimal care for members, often in a remote setting. The position requires current licensure (RN, LMSW, LCSW, LPC, LMFT, LAC, or Psychologist) with several years of post-degree clinical and behavioral health