Licensed Behavioral Health UM, RN, SW, Counseling, Psychology
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Job Description
Humana behavioral health utilization management professional coordinating medical necessity decisions and care for Louisiana members. Reviewing treatment criteria and communicating with providers in a remote Sunday–Thursday role.
Responsibilities:
- Support coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret behavioral health criteria, policies, and procedures to determine appropriate treatment, care, or services
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Apply clinical knowledge, communication, and independent critical thinking skills
- Make decisions regarding work methods in ambiguous situations with minimal direction
- Follow established guidelines and procedures
- Complete training Monday through Friday, 8:00 AM–5:00 PM Central Time
- Work Sunday through Thursday, 8:00 AM–5:00 PM Central Time after training and precepting
- Occasionally travel to Humana offices for training, meetings, or business needs
Requirements:
- Must reside in Louisiana
- Must meet one of the following licensure requirements with no history of disciplinary action: Licensed Registered Nurse (RN) – Multi-State Compact; or master's degree in a behavioral health-related field with a professional license from the state of Louisiana
- Qualifying licenses include LCSW, LMSW, LPC, LMFT, LAC, or Licensed Psychologist
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office, navigating multiple systems and platforms, and general technical troubleshooting in a remote environment
- Flexibility to accommodate an Eastern Time schedule, occasional weekends, and holidays
- Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Remote work arrangement
- Minimal travel, less than 5%
- Internet service requirements/support for home or hybrid home/office employees
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