Utilization Management Behavioral Health Professional 2 - Remote Kentucky

Profile

Description

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.

Responsibilities

The Utilization Management Behavioral Health Professional 2 completes telephonic reviews with the Utilization Reviewer at the Behavioral Health Facilities to obtain sufficient clinical information for the Medicaid population. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.

Complete telephonic reviews with facilities

Assess discharge plans

Coordinated with Care Coordination and Case Management

Discuss cases with Medical Directors

Complete documentation for Quality Reviews for Peer Reviews

Will travel to Louisville, KY for training a few times a year

Required Qualifications

Degree in Nursing or a Master's degree in a Behavioral Health related field such as Social Work, Counseling, and/or Psychology, from an accredited university.

Current Unrestricted Licensure in your profession in the state of KY :

Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Professional Counselor (LPCC), Registered Nurse (RN) or other professional Registered Nurse higher licensure

Minimum of three (3) years of post-degree clinical experience in direct patient care

Three (3) years or more of Behavioral Health experience

Minimum of two (2) years of Behavioral Health Utilization Management experience

Proficiency with Microsoft Office products

Experience working with computers

Location: Work at home state of Kentucky or Work At Home if located within an adjacent county of Kentucky (ie: WV, OH, VA, IL, IN)

Work At Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Desired Qualifications

Knowledge of community health and social service agencies and additional community resources in the state of Kentucky

Experience with remote working at home

Interview Process

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com