UM Behavioral Health Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Behavioral HealthIndustries

Requirements

Candidates must possess an applicable state licensure in the field of study in Kentucky without disciplinary action, such as LCSW, LMSW-ACP, LPC, or PhD. A minimum of three years of post-degree clinical experience in private practice or patient care is required, with experience in areas like child development, dissociation, hyperactivation, ABA, trauma responses, depression, anxiety, substance use, or geriatric care. One year of managed care or health plan experience is also necessary. Preferred qualifications include experience with utilization review, behavioral change, health promotion, coaching, wellness, working with pediatric to older adult populations, and knowledge of community health and social service agencies. Bilingual skills in English/Spanish are a plus. A minimum internet download speed of 25 Mbps and upload speed of 10 Mbps is required for remote work.

Responsibilities

The Utilization Management Behavioral Health Professional 2 will utilize behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. This role involves interpreting criteria, policies, and procedures to provide optimal care and treatment, coordinating with providers and members, and making independent decisions regarding work methods. The professional will also understand department, segment, and organizational strategy and operating objectives.

Skills

Behavioral Health

Clinical Social Work

Managed Care

Utilization Review

Coordination of Care

Benefit Administration

Critical Thinking

Child Development

Trauma Responses

Substance Use

Geriatric Care

Cognitive Function

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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