Licensed Behavioral Health UM (RN, SW, Counseling, Psychology)

Become a part of our caring community

The Licensed Behavioral Health Utilization Management Professional 2 uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Licensed Behavioral Health Utilization Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

This position requires residence in Oklahoma.

The Licensed Behavioral Health Utilization Management Professional 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. Understand 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.

Required Qualifications

You must meet one of the following licensure requirements with no history of disciplinary action:

OR

Master's degree in a behavioral health–related field (Social Work, Counseling, Psychology) with a professional license from the state of Oklahoma. (An additional independent Kentucky license is preferred).Licensed Clinical Social Worker (LCSW)Licensed Master Social Worker (LMSW)Licensed Professional Counselor (LPC)Licensed Marriage and Family Therapist (LMFT)Licensed Addiction Counselor (LAC)Licensed Psychologist

Candidates must meet ALL the following

3+ years of post-degree clinical experience in direct patient care.

3+ years of Behavioral Health experience

Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment

Preferred Qualifications

Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual.

Managed Care, Medicaid.

Health plan experience.

Additional Information

Schedule/Time Zone: Monday through Friday, 8:00 AM–5:00 PM Central Time. Flexibility required to accommodate an Eastern Time schedule, as well as occasional weekends and holidays, to meet business needs.

Work Location & Work Style: This is a remote position

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.