DescriptionThe 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.ResponsibilitiesThe 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.This position requires residence in the state of Kentucky or in a bordering county of Kentucky: Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West VirginiaRequired QualificationsApplicable Kentucky state licensure or a recognized COMPACT License in field of study without restriction.
Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), other professonal license with a Master's degree, or Registered Nurse (RN) with a Bachelor's degree.
Minimum three, (3) , years post degree practice experience in Behavioral Health such as social work, psychology, or related health discipline from an accredited university
Minimum one, (1), year of post-degree clinical experience in private practice or other patient care
Minimum one, (1), year managed care experience
Intermediate or better 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.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Additional Requirements / AdherenceWorkstyle: Remote Work at HomeLocation:Must reside in the state of Kentucky or within in a county contiguous state border: Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia
Schedule/Hours: Monday through Friday8:30 AM - 5:00 PM EasternTravel: Annual All Hands attendance one time yearly, usually in the spring, but is subject to change based on business needs.Work at Home RequirementsMust have a separate room with a locked door that can be used as a home office to ensure you absolute and continuous privacy while you work
Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)
Preferred QualificationsExperience with utilization review process
Knowledge of substance use disorders and recovery process
Experience with behavioral change, health promotion, coaching and wellness
Experience working with the older adult population
Knowledge of community health and social service agencies and additional community resources
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Additional InformationInterview FormatAs part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.Covid Compliance PolicyFor this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.If progressed to offer, you will be required to:Provide proof of full vaccination, including booster or commit to testing protocols
OR Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.