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

The Utilization Management Behavioral Health Professional 2 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.

The Utilization Management Behavioral Health Professional 2 uses 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 Louisiana and occasionally travel to local office for meetings
• Must hold one of the following qualifications:
  • Licensed Masters Clinical Social Worker (LCSW) OR
  • Licensed Professional Counselor (LPC) OR
  • Licensed Marriage and Family Therapists (LMFTs) OR
  • Licensed Addiction Counselors (LACs)
• Must be available to work 40 hour work week Monday – Friday, potential for overtime with some weekend and on-call rotation to meet business need
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook.
• Ability to use a variety of electronic information applications/software programs including electronic medical records

Preferred Qualifications

• 1 or more year of managed care experience
• Minimum two (2) years of direct care experience in an acute or outpatient behavioral health setting
• Experience with Utilization Management or Prior Authorization
• Experience utilizing MCG and American Society of Addiction Medicine Criteria
• Experience with behavioral change, health promotion, coaching and wellness
• Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.
• Knowledge of community health and social service agencies and additional community resources
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Work-At-Home Requirements

• Must have the ability to provide a high speed wireless, DSL or cable modem (including VPN tunnel)  for a home office.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  Satellite Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$63,400 - $87,400 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits a