Utilization Management Behavioral Health Professional
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Job Description
Behavioral health utilization management clinician reviewing care criteria and coordinating services for Humana members. Louisiana-based remote role supporting managed care determinations.
Responsibilities:
- Support coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret criteria, policies, and procedures to determine appropriate treatment, care, or services for members
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Follow established guidelines and procedures
- Report to the Behavioral Health Manager and participate in the Behavioral Health UM Team
- Work Monday through Friday during scheduled hours, with weekend and on-call rotations and potential overtime
- Complete a six-week training process
- Occasionally travel to Humana offices for training or meetings
Requirements:
- Master's level clinician with independent licensure in the state of Louisiana, such as LCSW, LPC, LMFT, or LAC
- 1+ year of managed care experience
- Familiarity with MCG and American Society of Addiction Medicine Criteria
- Proficiency using electronic information systems and Microsoft Office tools (Word, Outlook, Excel)
- Strong keyboard and web navigation skills
- Ability to provide clear narrative documentation
- Exceptional communication and interpersonal abilities
- Must be available for a 40-hour work week, Monday–Friday, 8:00 AM–5:00 PM CST
- Must cover weekend and on-call rotations as needed
- Must reside in Louisiana and perform work within the state
- Preferred: 2 years of direct care experience in an acute or outpatient behavioral health setting
- Preferred: Experience with Utilization Management or Prior Authorization
- Preferred: Experience with behavioral change, health promotion, coaching, and wellness
- Preferred: Experience serving Medicare, Medicaid, TANF, and/or CHIP populations
- Knowledge of community health and social service agencies and additional community resources
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Must work from a dedicated space protecting member PHI/HIPAA information
- Separation of two or more years from LDH is required for covered current or former LDH officials or employees
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
- Six-week training process
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings may be required
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