The Utilization Management Behavioral Health Professional 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.
This position will report to the Manager Care Management and be part of the Behavioral Health CM Team.
In this role you will:
•Apply 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
Use your skills to make an impact
Required Qualifications
•Master's level clinician with independent licensure in the state of Louisiana (i.e. Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapists (LMFTs) Licensed Addiction Counselors (LACs)
•1+ year of managed care experience
•Experience utilizing MCG and American Society of Addiction Medicine Criteria
•Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members.
•Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities.
•Must be available to work 40-hour work week Monday – Friday 8:00-5:00 PM CST, potential for overtime with an expectation to cover a weekend and on-call rotation to meet business needs
•Must reside in Louisiana and perform work within the state
Preferred Qualifications
•2 years of direct care experience in an acute or outpatient behavioral health setting
•Experience with Utilization Management or Prior Authorization
•Experience with behavioral change, health promotion, coaching and wellness
•Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.
•Knowledge of community health and social service agencies and additional community resources
•Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
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 required.
•Satellite, cellular and microwave connection can be used only if approved by leadership.
•Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
•Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
•Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$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.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
...to hire the very best people (that's you!), and give them everything they need to do their jobs beautifully. This Role Hours:Evening & Weekend (~10-15 hours within these windows) Weekdays: 5:00pm - 8:00pm Weekends: 8:00am - 8:00pm These hours aren't set in...
...environmental impact, and embracing social responsibility. Job Description Broad Function and Purpose of Position: The Quality Manager is responsible for the development, implementation and control of quality related initiatives including ISO9001 & IATF16949, as...
...Summary As a Designer, you will be responsible for creating accurate and detailed piping and instrumentation diagrams (P&IDs) using AutoCAD Plant 3D, AutoCAD, and Inventor software. The ideal candidate will have intermediate-level design experience in industrial or...
...family is seeking an experienced, proactive, and highly organized nanny/household assistant to help care for their 11-month-old child... ...needed Requirements: Prior nanny and household support experience required Must be highly organized, proactive, and take initiative...
### **Role Overview** We are seeking a detail-oriented, proactive **Remote Chat Moderator** to monitor, manage, and facilitate online conversations within our digital community platforms. Your primary goal will be to maintain a positive, safe, and engaging environment...