Licensed Behavioral Health UM, RN, SW, Counseling, Psychology

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

📋 Description

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

• Analyze behavioral health criteria, policies, and procedures to identify suitable treatment, care, or services.

• Collaborate and communicate with providers, members, and other stakeholders to ensure optimal care and treatment.

• Utilize independent critical thinking to determine the best courses of action.

• Adhere to established guidelines and procedures while working with minimal supervision.

• Conduct medical necessity reviews based on criteria such as MCG, ASAM, and InterQual.

• Work from Tuesday to Saturday, 8:00 AM–5:00 PM Central Time following training and precepting.

• Participate in training Monday through Friday, 8:00 AM–5:00 PM Central Time.

• Occasionally travel to Humana offices for training or meetings as business needs arise.

⛳️ Requirements

• Must fulfill one of the following licensure criteria with no record of disciplinary action: Licensed Registered Nurse (RN) – Multi-State Compact; or hold a master's degree in a behavioral health-related field with a professional license from the state of Louisiana.

• Acceptable licenses include LCSW, LMSW, LPC, LMFT, LAC, or Licensed Psychologist.

• A minimum of 3 years of post-degree clinical experience in direct patient care.

• At least 3 years of experience in Behavioral Health.

• Proficient in MS Office applications.

• Skilled in navigating multiple systems and platforms.

• General technical aptitude to troubleshoot and resolve issues in a remote setting.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

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

• Willingness to accommodate an Eastern Time schedule, including occasional weekends and holidays.

• Preferred: Experience in Behavioral Health UM with medical necessity reviews utilizing MCG, ASAM, or InterQual.

• Preferred: Experience in Managed Care or Medicaid.

• Preferred: Experience in a health plan environment.

🏝️ Benefits

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

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work arrangement.

• Minimal travel for office meetings 1–2 times annually as business needs require.