Become a part of our caring community and help us put health first
 

Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes 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.

• Utilizes clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Understands 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.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the state of Kentucky or a county that is contiguous to Kentucky state border in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia.
• Bachelor’s degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without disciplinary action. Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license.
• Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings.
• Intermediate working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word, systems, platforms, and an ability to troubleshoot and resolve general technical difficulties.
• Exceptional oral and written, communication, and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.

Preferred Qualifications

• Experience with utilization review process.
• Experience with behavioral change, health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.
• Knowledge and experience working with individuals with substance use diagnoses.
• Knowledge of substance use disorders and recovery process.

Additional Information

• Workstyle: This is a remote position.
• Workdays & Hours: Monday - Friday; 8:30 AM - 5:00 PM Eastern Standard Time (EST).
• Travel: Travel is required to our Annual All Hands meeting occurring once per year, typically in the spring. However, this may be subject to change based on business needs.

Work at Home Criteria

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates 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 associates 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 be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensa