Utilization Management Behavioral Health Professional

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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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Utilization Management Behavioral Health Professional uses 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 meet one of the following:
• Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) with Behavioral Health experience (ie. Inpatient psychiatric care, substance use treatment or other Behavioral Health treatment settings)
• Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia
• Must meet all of the following:
• Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting
• Minimum one, (1) year of managed care experience
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills

Preferred Qualifications

• 1+ years of 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

Additional Information

Workstyle: Remote work at Home

Schedule: Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs

Travel: Less than 5% to attend onsite market meetings as business needs

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.

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 $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.

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.