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Utilization Management Behavioral Health Professional

Humana

Humana

Oklahoma, USA · Remote
Posted on Thursday, January 25, 2024

Become a part of our caring community and help us put health first

*$5000 SIGN-ON BONUS* for new associates! $5000 payable within the first 45 days of hire.

At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.

Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.

About Humana Healthy Horizons

Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.

This associate will support the coordination, documentation, and communication of medical services and benefit administration determinations. This role's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

*$5000 SIGN-ON BONUS* for new associates! $5000 payable within the first 45 days of hire.

Responsibilities:

  • Uses clinical knowledge, communication skills and independent critical thinking skills to interpret criteria, policies and procedures to provide the best and most appropriate treatment, care, or services for Enrollees.
  • Coordinates and communicates with Providers, Enrollees, 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, requiring minimal direction and receiving guidance where needed
  • Follows established guidelines and procedures


Use your skills to make an impact

Required Qualifications

  • Must Reside in Oklahoma
  • An active Licensed Registered Nurse (RN), a licensed Master’s Level Social Worker (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT) or a Psychologist (PhD/EdD) in the State of Oklahoma without restrictions.
  • 3+ years of Behavioral Health experience
  • 2+ years Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual
  • 3+ years post-degree clinical experience in direct patient care
  • Ability to work independently.
  • Periodic travel to Humana Oklahoma City office for meetings and training

Travel

Must have a Valid driver’s license with reliable transportation and the ability to travel within the state, as required

This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Work at Home Criteria

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.

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.

Scheduled Weekly Hours

40


About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.