Utilization Management - Behavioral Health Professional

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

Job summary

Join a forward-thinking organization that prioritizes health and wellness. As a Utilization Management Behavioral Health Professional, you'll leverage your clinical expertise to support individuals in achieving optimal health outcomes. This remote position offers a dynamic work environment where you can make a significant impact on the lives of members. You will coordinate care, engage with providers, and utilize your critical thinking skills to navigate complex situations. Embrace the chance to contribute to a compassionate community dedicated to improving health and well-being for all. If you're passionate about making a difference, this is the perfect opportunity for you.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Qualifications

• Must reside in Kentucky or contiguous state with appropriate licensure.
• 3+ years of clinical experience in healthcare settings.

Responsibilities

• Coordinate and communicate with providers and members for optimal care.
• Interpret criteria and policies to provide appropriate treatment.

Skills

Clinical Knowledge

Communication Skills

Critical Thinking

Interpersonal Skills

Education

Bachelor’s degree in nursing

Master’s degree in Human Services

Tools

Microsoft Office (Teams, Excel, PowerPoint, Outlook, Word)

Job description

Become a part of our caring community and help us put health first
Humana 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. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Utilizes 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.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Must reside in the state of Kentucky or a county that is contiguous to Kentucky state border in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia.
• 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 Teams, 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 with utilization review process.
• Experience with behavioral change, health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.
• Knowledge and experience working with individuals with substance use diagnoses.
• 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 Standard Time (EST).
• Travel: Travel is required to 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 Criteria

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.