Licensed Behavioral Health UM, RN, SW, Counseling, Psychology
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Job Description
Licensed behavioral health utilization management professional supporting Humana’s healthcare services through clinical reviews, care coordination, and benefit determinations. Remote Louisiana role requiring behavioral health licensure and experience.
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 skills, and independent critical thinking
- Understand department, segment, and organizational strategy and operating objectives
- Make decisions regarding work methods in occasionally ambiguous situations with minimal direction
- Follow established guidelines and procedures
- Work remotely and occasionally travel to Humana offices for training or meetings
Requirements:
- Must reside in Louisiana
- 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 (Social Work, Counseling, Psychology) with a professional license from the state of Louisiana
- An additional independent Kentucky license is required for the behavioral-health-related master's-degree pathway
- Eligible 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
- Monday through Friday, 8:00 AM–5:00 PM Central Time; flexibility for Eastern Time scheduling, occasional weekends, and holidays
- Minimum internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Preferred: Behavioral Health UM experience with MCG, ASAM, or InterQual criteria
- Preferred: Managed Care or Medicaid experience
- Preferred: Health plan experience
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
- Self-provided internet service for remote work
- Occasional travel to Humana offices for training or meetings
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