Utilization Management Behavioral Health Professional

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

📋 Description

• Assist in the coordination, documentation, and communication related to medical services and the administration of benefits determinations.

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

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

• Adhere to established guidelines and procedures.

• Report to the Behavioral Health Manager and contribute to the Behavioral Health Utilization Management Team.

• Work Monday through Friday during designated hours, with potential weekend and on-call rotations, as well as overtime opportunities.

• Complete a comprehensive six-week training program.

• Occasionally travel to Humana offices for training sessions or meetings.

⛳️ Requirements

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

• A minimum of 1 year of experience in managed care.

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

• Proficient in using electronic information systems and Microsoft Office applications (Word, Outlook, Excel).

• Strong skills in keyboarding and web navigation.

• Capability to produce clear narrative documentation.

• Excellent communication and interpersonal skills.

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

• Willingness to cover weekend and on-call rotations as required.

• Must reside in Louisiana and complete work within the state.

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

• Preferred: Experience in Utilization Management or Prior Authorization.

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

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

• Knowledge of community health and social service agencies and other community resources.

• Minimum home internet speed of 25 Mbps for downloads and 10 Mbps for uploads.

• Must work from a designated area that safeguards member PHI/HIPAA information.

• A separation of two or more years from the Louisiana Department of Health is required for any current or former officials or employees.

🏝️ Benefits

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

• Medical, dental, and vision insurance options.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance benefits.

• Six-week training program.

• Flexible remote work arrangement.

• Occasional travel to Humana offices for training sessions or meetings may be necessary.