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Utilization Management Behavioral Health Professional at Humana - ApplyBlast

Utilization Management Behavioral Health Professional

Humana

3 months ago

3.6 on Glassdoor

Remote

Full Time

Senior

0 applicants

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About this role

The Utilization Management Behavioral Health Professional uses clinical knowledge and critical thinking to coordinate medical services and determine benefit administration for members. This role involves interpreting policies, communicating with providers, and making independent decisions regarding appropriate treatment courses of action. Candidates must hold an active nursing or clinical license in Virginia with at least one year of post-degree clinical and managed care experience.

Responsibilities

Coordinate and document medical services for behavioral health members
Interpret clinical criteria and policies to determine treatment appropriateness
Communicate with providers and members to facilitate optimal care
Make independent decisions regarding work methods in ambiguous situations
Navigate multiple systems and platforms to resolve technical difficulties

Skills

Qualifications

Active unrestricted registered nurse license in VirginiaActive unrestricted LCSW, LPC, LMFT, or LCP license1 year post-degree clinical experience1 year managed care experience

About Humana

humana.com

Headquarters

Louisville, Kentucky, United States

Company Size

10001+ employees

Founded

1961

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