Behavioral Health UM Professional, Medicaid

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in the coordination, documentation, and communication related to medical services and benefit administration decisions.

• Analyze criteria, policies, and procedures to ascertain the suitable treatment, care, or services.

• Utilize clinical expertise, communication abilities, and independent critical thinking to enhance member care.

• Facilitate communication and coordination with providers, members, and other stakeholders to ensure optimal care and treatment.

• Make autonomous decisions regarding work methodologies and action plans.

• Adhere to established guidelines and procedures.

• Participate in occasional meetings and training sessions at Humana offices when necessary.

⛳️ Requirements

• Bachelor's degree in Nursing or a Master's degree in a behavioral health-related discipline from an accredited institution.

• Over 3 years of post-degree clinical experience in behavioral health, delivering direct patient care.

• Current, unrestricted licensure as an LCSW, LMSW-ACP, LPC, RN with an active compact license, or another recognized behavioral health professional license.

• Availability to work from Tuesday to Saturday, 8:00 AM to 5:00 PM Eastern Time.

• Capability to work remotely from a designated area without continuous interruptions to safeguard member PHI/HIPAA information.

• Self-provided internet service with a minimum download speed of 25 Mbps and upload speed of 10 Mbps.

• Preferred: At least 1 year of experience within a Managed Care and Medicaid setting.

• Preferred: Background in conducting Behavioral Health Utilization Management reviews and medical necessity assessments using MCG, ASAM, and/or InterQual.

• Preferred: Experience in behavioral change methodologies, health promotion, coaching, or wellness programs.

• Preferred: Bilingual proficiency in English and Spanish, encompassing speaking, reading, writing, interpreting, and explaining documents in Spanish.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Comprehensive well-being and personal wellness support.

• Remote work arrangement.

• Travel of less than 5% may be necessary for meetings and training.