Become a part of our caring community
 

Humana Healthy Horizons is looking for a Utilization Management Behavioral Health Professional 2 who uses behavioral health knowledge to support the coordination, documentation, and communication of medical services 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.
You will be part of a caring community at Humana.
When you meet us, you can tell we started as a hometown company. We're proud of our Louisville roots and, as we've grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you're working from home, from the field, from our offices, or from somewhere in between—you'll feel welcome here. We're a caring community that makes close-knit teams, forges cross-country friendships, and forms inclusive resource groups, all gathering around one big table where we hear and respect everyone's voice. Community is a verb here. It's up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.
Are you Caring, Curious and Committed? If so, apply today!

The Utilization Management Behavioral Health Professional 2

• Use clinical knowledge, towards interpreting criteria and procedures to provide the best treatment, care or services for members
• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed
• Follow established guidelines/procedures.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree from an accredited institution.
• 1+ year of post-degree clinical experience in a private practice or patient care setting
• Active, unrestricted licensure in one of the following disciplines:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Masters Social Worker (LMSW-ACP)
  • Licensed Professional Counselor (LPC)
  • Registered Nurse (RN)
  • Or another behavioral health professional license recognized by applicable state regulations.

Preferred Qualifications

• Master’s degree from an accredited institution.
• 1+ year of experience working in a managed care environment.
• Experience utilizing ASAM, MCG, or InterQual clinical guidelines.
• Demonstrated subject matter expertise in utilization review for inpatient and outpatient behavioral health services.
• Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual proficiency in English and Spanish, with the ability to speak, read, write, interpret, and explain documents in Spanish (See additional information under the Language Assessment Statement)

Additional Information

• Schedule/Time Zone: Monday through Friday, 8:00 AM – 5:00 PM with flexibility to work overtime/weekends as needed.
• Work Location: US
• Work Style: Remote

Work-at-Home (WAH) Internet Statement: 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.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format: As part of our hiring process for this opportunity, we will b