UM Behavioral Health Professional

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The Utilization Management Behavioral Health Professional uses 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 uses 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.

They use these skills towards interpreting criteria, policies, and procedures. The goal is to provide the best and most appropriate treatment, care, or services for members. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. Understand 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.

• Applicable State licensure in field of study without disciplinary action.
• Such licenses are:
  Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), or other professional license
• Minimum three, (3) years of post-degree clinical experience in private practice or other patient care. (i.e., child development, dissociation, hyperactivation, ABA, trauma responses, depression, anxiety, substance use, geriatric care focusing on age-related cognitive function
• Minimum one, (1) year of managed care/health plan experience

• Experience with pre-authorization/utilization review processes
• Experience with behavioral change, health promotion, coaching and wellness
• Experience working with pediatric to older adult population
• Knowledge of community health and social service agencies and additional community resources
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Remote Work at Home

U.S.

- Must have an active Professional license without disciplinary action or restrictions

Typically, M-F 8:00 AM to 5:00 PM Eastern Time

Not a primary requirement in the role, but may occur as business needs

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…