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Utilization Management Behavioral Health Professional (LMHP)

Humana

Humana

Louisiana, USA · Remote
Posted on Saturday, September 9, 2023

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 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.

  • 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

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Required Qualifications

Must meet one of the following:

  • Licensed Masters Clinical Social Worker (LCSW) OR
  • Licensed Professional Counselor (LPC) OR
  • Licensed Marriage and Family Therapists (LMFTs) OR
  • Licensed Addiction Counselors (LACs)

Must meet all of the following:

  • Experience with Utilization Management or Prior Authorization
  • 1+ years of managed care experience
  • Minimum two (2) years of direct care experience in an acute or outpatient behavioral health setting
  • Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.
  • Must be available to work 40 hour work week Monday – Friday with some Weekend Rotation
  • Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook.
  • Ability to use a variety of electronic information applications/software programs including electronic medical records
  • Must reside in Louisiana and occasionally travel to local office for meetings

Work-At-Home 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 behavioral change, health promotion, coaching and wellness
  • Knowledge of community health and social service agencies and additional community resources
  • Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Additional Information

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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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.

Louisiana Health Department (LDH)

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

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Scheduled Weekly Hours

40