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 decisions related to benefit administration.

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

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

• Comprehend the strategies and operational objectives of the department, segment, and organization.

• Make informed decisions regarding work methods, even in ambiguous situations, with minimal guidance.

• Adhere to established guidelines and procedures.

• Occasionally travel to Humana offices for training or meetings.

• Participate in the annual All Hands meeting, which occurs typically once a year.

⛳️ Requirements

• A Bachelor’s degree in nursing or a master’s degree in a Human Services field.

• A professional individual or compact licensure in the state of Kentucky without any disciplinary actions, such as LCSW, LMFT, LPC, PhD psychologist, 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.

• Familiarity with various systems and platforms.

• Capability to troubleshoot and resolve common technical issues.

• Outstanding oral and written communication and interpersonal skills.

• Ability to establish rapport with internal and external customers and stakeholders.

• Availability to work Sunday through Thursday from 8:30 AM to 5:00 PM Eastern Time.

• Minimum home internet speed of 25 Mbps for download and 10 Mbps for upload.

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

🏝️ 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, typically occurring once a year.

• Remote work opportunities.

• Work-from-home arrangements.

• Self-provided internet service support, subject to specified requirements.