Remote Utilization Management Behavioral Health Professional RN

Humana

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Location: Louisville, KY
Schedule: Full_time
Req: R-315032

Description

 

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.

 

Responsibilities

 

The Utilization Management Behavioral Health Professional 2 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.

  • Performs utilization management tasks including triage, concurrent, prepayment/claims and other related functions for clinical role
  • Performs designated inbound call center coverage tasks
  • Perform other duties as assigned by Supervisor, Manager and/or Director

               

Required Qualifications

The Utilization Management Behavioral Health Professional must meet ONE of the following license requirements:

 

A current, valid, and unrestricted license to include:
Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist (PhD), Licensed Professional Counselor (LPC) with;

  • Master’s degree
  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience

OR
A current, valid, and unrestricted nursing license Registered Nurse (R.N.) with;

  • Associates degree in Nursing
  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience

The U.M. Behavioral Health Professional must meet ALL the following requirements:

  • Ability to work an 8-hour shift, Monday through Friday 9:00 a.m. to 6:00 p.m. Central Standard Time (10 a.m. to 7 p.m. Eastern Standard Time)
  • Our Department of Defense Contract requires U.S. citizenship for this position
  • Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)

Work at Home/Remote Requirements
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

  • Experience with utilization review process
  • Experience with behavioral change, health promotion, coaching and wellness
  • Experience working with the older adult population
  • Knowledge of community health and social service agencies and additional community resources
  • Prior experience working directly or indirectly with the military or Tricare population
  • Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Additional Information

Work Style: Remote
Work Days/Hours: Monday – Friday; 9:00 a.m.-6 p.m. Central Standard Time (CST)

 

SSN Alert Statement:  Humana values personal identity protection. Please be aware that applicants selected for leader review 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.

 

Modern hire:
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.

 

This is a remote position
#LI-Remote

 

Scheduled Weekly Hours

 

40