Utilization Management Behavioral Health Professional

Humana; Oregon; Hybrid; USD 65,000 - 89,000; Full time

Job summary

Humana is seeking a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and determinations for medical services and benefits. The role is remote, with duties that require clinical knowledge, independent decision-making, and adherence to guidelines.

The position requires a nursing degree or a master's in a Human Services field with Kentucky licensure, 3+ years of post-degree clinical experience, and proficiency with MS Office.

Qualifications

• Bachelor's in nursing or master's in a Human Services field with Kentucky licensure.
• 3+ years of post-degree clinical experience in healthcare settings.
• Proficient in MS Office (Excel, PowerPoint, Outlook, Word).
• Excellent written and oral communication; ability to build rapport.

Responsibilities

• Interpret criteria, policies and procedures to determine appropriate care or services.
• Coordinate and communicate with providers, members and stakeholders.
• Work with team to align actions with department and organizational goals.
• Make independent decisions within guidelines and seek guidance when needed.

Skills

Clinical experience

Communication skills

Critical thinking

MS Office

Education

Bachelor's in Nursing

Master's in Human Services

Tools

Excel

PowerPoint

Outlook

Word

Job description

Become a part of our caring communityHumana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. You will work on assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Utilize 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.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed.
• Follow established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without disciplinary action. Such licenses are: Licensed Masters Clinical Social Worker ( LCSW) , Licensed Marriage and Family Therapist (LMFT) , Licensed Professional Counselor (LPC) , Psychologist (PhD) , Registered Nurse (RN) or other professional license.
• Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings.
• Intermediate working knowledge using Microsoft Office Programs specifically Excel, PowerPoint, Outlook and Word, systems, platforms, and an ability to troubleshoot and resolve general technical difficulties.
• Exceptional oral and written, communication, and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.

Preferred Qualifications

• Experience working within a managed care organization or a health plan.
• Experience with utilization review process.
• Experience with behavioral change, health promotion, coaching and wellness.
• Experience working with individuals with substance use diagnoses.
• Knowledge of community health and social service agencies and additional community resources.
• Knowledge of substance use disorders and recovery process.

Additional Information

• Workstyle: This is a remote position.
• Workdays & Hours: Monday - Friday; 8:30 AM - 5:00 PM Eastern Time (ET).
• Travel: Travel is required for our Annual All Hands meeting occurring once per year, typically in the spring. However, this may be subject to change based on business needs.

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.

Application Deadline: 01-28-2027

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.