Utilization Management Behavioral Health Professional

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

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to coordinate, document and communicate medical services and benefit determinations. The role requires clinical judgment, strong communication, and independence, with travel as needed and a full-time schedule.

Qualifications include a nursing degree or a relevant master's with Kentucky licensure, plus 3+ years of clinical experience and proficiency in Microsoft Office.

Qualifications

• Bachelor’s degree in nursing or a master’s degree in a Human Services field with licensure in Kentucky.
• Three or more years of post-degree clinical experience.
• Intermediate working knowledge of Microsoft Office programs (Excel, PowerPoint, Outlook and Word) and troubleshooting.
• Exceptional oral and written communication and interpersonal skills.

Responsibilities

• Interpret criteria, policies, and procedures to provide the best and most appropriate treatment 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.
• Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction.
• Follow established guidelines/procedures.

Skills

Oral & written communication

Critical thinking

Independent work

Interpersonal skills

Excel/Office skills

Education

Bachelor's degree in nursing

Master's degree in Human Services field with licensure in Kentucky

Professional license (LCSW/LMFT/LPC/PhD/RN)

Tools

Microsoft Office (Excel, PowerPoint, Outlook, Word)

Job description

Become a part of our caring community

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. 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 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, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities.

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 atHumana.comand atCenterWell.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.