Utilization Management Behavioral Health Professional

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

📋 Description

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

• Analyze criteria, policies, and procedures to ensure suitable treatment, care, or services for members.

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

• Utilize behavioral health expertise, clinical knowledge, communication abilities, and independent critical thinking.

• Comprehend the department, segment, and organizational strategies and operational objectives, and their connections to related areas.

• Make decisions regarding work methodologies, even in ambiguous situations, with minimal supervision.

• Adhere to established guidelines and procedures.

• Participate in the annual All Hands meeting and may occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Bachelor’s degree in nursing OR a master's degree in a Human Services field.

• Professional individual or compact licensure in the state of Kentucky without any disciplinary actions, such as LCSW, LMFT, LPC, Psychologist (PhD), RN, or another professional license.

• A minimum of three (3) years of post-degree clinical experience in private practice or other healthcare environments.

• Intermediate proficiency in Microsoft Office Programs, particularly Excel, PowerPoint, Outlook, and Word.

• Capability to utilize systems and platforms, along with troubleshooting and resolving general technical issues.

• Outstanding oral and written communication and interpersonal abilities.

• Skill in establishing rapport with internal and external customers and stakeholders.

• Experience within a managed care organization or health plan is preferred.

• Familiarity with the utilization review process is preferred.

• Background in behavioral change, health promotion, coaching, and wellness is preferred.

• Experience working with individuals with substance use diagnoses is preferred.

• Knowledge of community health and social service agencies, as well as additional community resources, is preferred.

• Understanding of substance use disorders and the recovery process is preferred.

• Availability to work Tuesday–Saturday, 8:30 AM–5:00 PM Eastern Time.

• Willingness to occasionally travel to Humana offices for training or meetings.

🏝️ 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.

• Annual All Hands meeting travel.

• Remote work arrangement.

• Dedicated home workspace and internet requirements to support remote work.