Remote Utilization Management Behavioral Health Professional 2

Humana

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Location: OK
Location Type: Remote
Schedule: Full_time
Req: R-324022

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 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 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. license is required. 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.

               

Required Qualifications

  • Degree in Nursing or a Master’s degree in a behavioral health-related field, such as Social Work, Counseling, or Psychology from an accredited university
  • Must be licensed Registered Nurse or a licensed Master’s Level Social Worker in the State of Oklahoma with no disciplinary action
  • Minimum three, (3), years of post-degree clinical experience in direct patient care,
  • Minimum three, (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.
  • Ability to work independently.

Workstyle: Remote Work at Home

Location:  Oklahoma

Schedule:  Monday through Friday 8:00-5:00 PM Central Time

  • Flexibility to accommodate Eastern Time Schedule to meet business needs

Travel:  Periodic travel to Humana Oklahoma City office for meetings and training

 

Work at Home Guidance 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 recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Employees 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 employees 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

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

Managed Care, Medicaid

Health plan experience

 

Additional Information:

 

Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

 

SSN Alert Statement

 

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

 

Benefits Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1, Paid time off, holidays, volunteer time and jury duty pay, Recognition pay, 401(k) retirement savings plan with employer match,
Tuition assistance, Scholarships for eligible dependents, Parental and caregiver leave, Employee charity matching program, Network Resource Groups (NRGs), and Career development opportunities.

 

#L1-Remote

 

Scheduled Weekly Hours

 

40