Licensed Behavioral Health Utilization Management Professional
New
H
HumanaBehavioral health
Source API remote eligibility restrictions: United States, Central Time schedule; flexibility required to accommodate an Eastern Time schedule.Full-TimeMiddle
Salary$65,000 - $88,600 per year
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Job Details
- Experience
- 3+ years of post-degree clinical experience in direct patient care; 3+ years of Behavioral Health experience
- Required Skills
- MS Office
Requirements
- Meet one of the stated licensure requirements with no history of disciplinary action.
- Qualifying licensure includes a Registered Nurse (RN) – Multi-State Compact license.
- Alternatively, hold a master's degree in a behavioral health-related field such as Social Work, Counseling, or Psychology, with a professional license from Louisiana.
- Listed professional licenses include LCSW, LMSW, LPC, LMFT, LAC, and Licensed Psychologist.
- An additional independent Kentucky license is preferred.
- Have 3+ years of post-degree clinical experience in direct patient care.
- Have 3+ years of Behavioral Health experience.
- Be proficient with MS Office, multiple systems and platforms, and general technical troubleshooting in a remote environment.
- Behavioral Health UM experience performing medical necessity reviews against criteria such as MCG, ASAM, or InterQual is preferred.
- Managed Care, Medicaid, and health plan experience are preferred.
- After training and precepting, work Tuesday through Saturday, 8:00 AM–5:00 PM Central Time; flexibility for Eastern Time scheduling and occasional weekends and holidays is required.
- Maintain a dedicated workspace without ongoing interruptions and internet service with at least 25 Mbps download and 10 Mbps upload speeds.
- Travel less than 5%, including occasional office meetings or training as business needs require.
Responsibilities
- Interpret behavioral health criteria, policies, and procedures to determine appropriate treatment, care, or services for members.
- Support coordination, documentation, and communication of medical services and benefit administration determinations.
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
- Apply clinical knowledge, communication skills, and independent critical thinking to utilization management work.
- Follow established guidelines and procedures while making decisions about work methods.
- Work Tuesday through Saturday, 8:00 AM–5:00 PM Central Time after training and precepting.
- Accommodate an Eastern Time schedule and occasional weekends and holidays as business needs require.
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