Behavioral Health Professional - Utilization Management

Louisiana, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must possess a Master's level clinician license in Louisiana (LCSW, LPC, LMFT, LAC), have at least 1 year of managed care experience, and be proficient in using MCG and ASAM criteria. Intermediate to advanced computer skills, including Microsoft Word, Excel, and Outlook, are required, along with the ability to use various electronic information applications. Candidates must be available for a 40-hour work week, potentially including overtime and on-call rotations, and reside and work within Louisiana. Additionally, a minimum internet download speed of 25 Mbps and upload speed of 10 Mbps is necessary for remote work, and individuals with recent direct experience working with the Louisiana Health Department's Medicaid Division may not be eligible.

Responsibilities

The Utilization Management Behavioral Health Professional will use behavioral health knowledge to support the coordination, documentation, and communication of medical services and benefit determinations. This role involves interpreting criteria, policies, and procedures to ensure members receive appropriate treatment, care, or services. Responsibilities include coordinating and communicating with providers, members, and other parties to facilitate optimal care, making independent decisions regarding work methods, and adhering to established guidelines and procedures.

Skills

Behavioral Health

Utilization Management

Medical Services Coordination

Benefit Administration

Clinical Knowledge

Communication Skills

Critical Thinking

MCG Criteria

ASAM Criteria

Microsoft Word

Microsoft Excel

Microsoft Outlook

Electronic Medical Records

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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