Utilization Management Behavioral Health Professional

Become a part of our caring community

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. You will work on assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Utilize 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.

Coordinate and communicate 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.

Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed.

Follow established guidelines/procedures.

Required Qualifications

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 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 working within a managed care organization or a health plan.

Experience with utilization review process.

Experience with behavioral change, health promotion, coaching and wellness.

Experience working with individuals with substance use diagnoses.

Knowledge of community health and social service agencies and additional community resources.

Knowledge of substance use disorders and recovery process.

Additional Information

Workstyle: This is a remote position.

Workdays & Hours: Tuesday - Saturday; 8:30 AM - 5:00 PM Eastern Time (ET).

Travel: Travel is required for 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 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.