6 days old

Senior Utilization Management Behavioral Health Professional

Humana
Boston, MA 02133
Description Come help us redefine the future of health care! With a history of transformation over the last 50 years, Humana is once again transforming itself using a startup approach. Reporting to the Director of Utilization Management, the Senior Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors as well as a passion to rethink our approach to get our members to the care they need and deserve by the right person, in the right location, when they need it. This is a unique opportunity to work within a multidisciplinary team transforming the utilization experience for providers and seniors using tech-enabled services to deliver on that experience from the ground up. We are looking for individuals who are passionate about transforming our care system for patients and providers and are driven by doing well by an insightful risk-taker willing to thoughtfully disrupt the status quo and excited to work in a rapidly evolving and agile start-up environment. Responsibilities The Senior Utilization Management Behavioral Health Professional 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. Begins to influence departments strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Required Qualifications + Bachelor's or Master's degree + Applicable State licensure in field of study + Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license + Health professional with a minimum of an associate's degree in nursing or at least three years practice experience, or a master's degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university + 1 or more years of post-degree clinical experience in private practice or other patient care + 1 or more year of managed care experience + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Up to 20% Travel 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 + Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish Additional Information This role will be located Louisville, KY or Boston MA Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2020-03-23 Expires: 2020-04-22

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Senior Utilization Management Behavioral Health Professional

Humana
Boston, MA 02133

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