Utilization Management Behavioral Health Professional

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

Job summary

Humana Inc in Louisiana seeks a Master-level clinician to join Utilization Management Behavioral Health. You will interpret criteria, coordinate care, document actions, and communicate with providers and members to ensure appropriate treatment and efficient benefit determinations. The role requires independent licensure and 1+ year of managed care experience, plus strong documentation skills and collaboration with the Behavioral Health UM Team.

Qualifications

• Master's level clinician with independent licensure in Louisiana (LCSW/LPC/LMFT/LAC).
• 1+ year of managed care experience.
• Familiarity with MCG and American Society of Addiction Medicine Criteria.

Responsibilities

• Apply clinical knowledge and independent critical thinking to interpret criteria, policies, and procedures for best care decisions.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Document and communicate effectively with internal partners and members using electronic systems.

Skills

Clinical licensure Louisiana (LCSW/LPC

Managed care experience

MCG/ASAM criteria

MS Office proficiency

Communication and documentation

Education

Master's degree in social work/related field

Tools

Microsoft Office

Job description

# **Become a part of our caring community**The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.This position will report to the Behavioral Health Manager and be part of the Behavioral Health UM Team.**In this role you will:*** Apply 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.* Follows established guidelines/procedures# **Use your skills to make an impact****Required Qualifications*** Master's level clinician with independent licensure in the state of Louisiana (i.e. Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapists (LMFTs) Licensed Addiction Counselors (LACs)* 1+ year of managed care experience* Familiarity with MCG and American Society of Addiction Medicine Criteria* Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members.* Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities.* Must be available to work 40-hour work week Monday – Friday 8:00-5:00 PM CST, potential for overtime with an expectation to cover a weekend and on-call rotation to meet business needs* Must reside in Louisiana and perform work within the state**Preferred Qualifications*** 2 years of direct care experience in an acute or outpatient behavioral health setting* Experience with Utilization Management or Prior Authorization* Experience with behavioral change, health promotion, coaching and wellness* Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.* Knowledge of community health and social service agencies and additional community resources**Additional Information****Location**: Must reside and perform work in Louisiana**Training:** 6-week training process**Hours:** Must be able to work a 40-hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, weekend rotations are required (the work week will be flexed**)** and over-time may be requested to meet business needsSection 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**Scheduled Weekly Hours**40**Pay Range**The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.