Utilization Management Behavioral Health Professional

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

📋 Description

• Utilize behavioral health expertise, communication abilities, and independent critical thinking to understand criteria, policies, and procedures.

• Assess and identify suitable treatment, care, or services for members.

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

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

• Adhere to established guidelines and procedures.

• Record, communicate, and collaborate through electronic information systems and Microsoft Office applications.

• Deliver clear narrative documentation and foster relationships with members and internal partners.

• Participate in a weekend and on-call rotation as necessary to fulfill business requirements.

⛳️ Requirements

• Master's level clinician with independent licensure in Louisiana, such as LCSW, LPC, LMFT, or LAC.

• Minimum of 1 year of experience in managed care.

• Familiarity with MCG and American Society of Addiction Medicine Criteria.

• Competence in using electronic information systems and Microsoft Office tools, including Word, Outlook, and Excel.

• Strong keyboard skills and web navigation proficiency.

• Capability to produce clear narrative documentation.

• Outstanding communication and interpersonal skills.

• Must be available for a 40-hour work week, Monday to Friday, from 8:00 AM to 5:00 PM CST.

• Required to reside in Louisiana and conduct work within the state.

• Must have a minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• Dedicated workspace free from continuous interruptions to safeguard member PHI/HIPAA information.

• Preferred: 2 years of direct care experience in an acute or outpatient behavioral health environment.

• Preferred: Experience with Utilization Management or Prior Authorization processes.

• Preferred: Background in behavioral change, health promotion, coaching, and wellness.

• Preferred: Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.

• Preferred: Awareness of community health and social service agencies along with other community resources.

• Preferred: Bilingual proficiency in English and Spanish.

🏝️ Benefits

• Bonus incentive plan.

• 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.

• Home-based work arrangement.

• Potential for overtime.

• Occasional travel to Humana offices for training or meetings.