Remote Behavioral Health Utilization Specialist

Visa Hunt; United States; On-site; USD 65,000 - 89,000; Full time

Job summary

Humana is seeking a behavioral health professional to perform utilization management, clinical reviews, and coordination across care teams. The role involves medical necessity determinations for behavioral health services, collaboration with providers, and documentation in the clinical system.

Responsibilities include applying guidelines, ensuring regulatory compliance, and contributing to performance improvement projects, with a Monday–Friday pattern and remote work options.

Qualifications

• Licensed clinicians with behavioral health credentials or advanced practice licenses.
• 1+ year of post-degree clinical experience in private practice or patient care.
• Experience with utilization review and Medicaid/Medicare policies is a plus.

Responsibilities

• Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity.
• Apply evidence-based clinical guidelines in review decisions.
• Ensure compliance with accreditation, state, and federal regulations.
• Communicate with healthcare providers to obtain necessary clinical information.
• Coordinate with medical directors and interdisciplinary teams to support decision-making.
• Document all review findings in the clinical documentation system.
• Support reporting initiatives and provide data for performance improvement projects.

Skills

LCSW

LMSW-ACP

LPC

PhD in Psychology

RN IL BH experience

1+ year clinical experience

Education

MSW

PhD in Psychology

RN license in IL

Job description

Humana is seeking a behavioral health professional to perform utilization management, clinical reviews, and coordination across care teams. The role involves medical necessity determinations for behavioral health services, collaboration with providers, and documentation in the clinical system.

Responsibilities include applying guidelines, ensuring regulatory compliance, and contributing to performance improvement projects, with a Monday–Friday pattern and remote work options.