Behavioral Health UM Professional, Medicaid (Tue-Sat)

The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

• Bachelor's degree in Nursing or a Master's degree in a behavioral health-related field (Social Work, Counseling, Psychology, or a related discipline) from an accredited college or university.
• 3+ years of post-degree behavioral health clinical experience providing direct patient care
• Active, unrestricted licensure in one of the following disciplines:
• Licensed Clinical Social Worker (LCSW)
• Licensed Masters Social Worker (LMSW-ACP)
• Licensed Professional Counselor (LPC)
• Active Compact License Registered Nurse (RN)
• Or another behavioral health professional license recognized by applicable state regulations.

Preferred Qualifications

• 1+ year of experience working in a Managed Care and Medicaid environment.
• Experience conducting Behavioral Health Utilization Management (UM) reviews, including medical necessity determinations using clinical guidelines such as MCG, ASAM, and/or InterQual.
• Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual proficiency in English and Spanish, with the ability to speak, read, write, interpret, and explain documents in Spanish (See additional information under the Language Assessment Statement)

Additional Information

• Schedule/Time Zone: Tuesday through Saturday, 8:00 AM to 5:00 PM Eastern Time. Flexibility to work an Eastern Time schedule is required to meet business needs.
• Work Location: US Nationwide
• Work Style: Remote
• Travel Requirements: Less than 5% travel may be required to attend meetings and training at a Humana office.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.