Utilization Management Behavioral Health Professional

Profile

Description

Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional to join our team. The Utilization Management (UM) Behavioral Health (BH) Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. Join this dedicated team and lead change in how health care for the underserved in Kentucky is managed.

Responsibilities

The UM BH Professional completes telephonic reviews with the Utilization Reviewer at behavioral health facilities to obtain sufficient clinical information for the Medicaid population. The UM BH Professional uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.

Completes telephonic reviews with facilities.

Assesses discharge plans.

Coordinates with Care Coordination and Case Management.

Discusses cases with Medical Directors.

Completes documentation for quality reviews for peer reviews.

Required Qualifications

Master's degree in a behavioral health-related field such as Social Work, Counseling, or Psychology, from an accredited university OR bachelor's degree in Nursing.

Applicable Kentucky state licensure in field of study: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Licensed Marriage and Family Therapist (LMFT), other professional license, OR Registered Nurse (RN) with Kentucky state or compact license.

Three (3) or more years of post-degree clinical experience in direct patient care.

Three (3) or more years of Behavioral Health experience.

Proficiency with Microsoft Office products, specifically Outlook, Teams, and OneNote.

Experience working in electronic medical records.

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI/ HIPAA information.

Preferred Qualifications

Utilization management experience, preferably in an outpatient setting.

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

Understanding of substance use disorders.

Additional Information

Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

Work Location: must reside in the state of Kentucky or in a contiguous county bordering Kentucky (Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia).

Travel: required to travel to home office in Louisville once per year for in-person meeting.

Typical Work Days/Hours: Monday - Friday, 8:30 am - 5:00 pm Eastern Time Zone (EST).

Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes: 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more!

Interview Format

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 or computer 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.

Social Security Alert

Humana Values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

#LI-JP1

Scheduled Weekly Hours

40

Humana 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=Humana_Website.

Company info

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