Utilization Management Behavioral Health Professional

Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Behavioral HealthIndustries

Requirements

Candidates must reside in Kentucky or a contiguous county in an adjacent state and possess a Bachelor's degree in nursing or a Master's degree in a Human Services field with a valid Kentucky professional license (LCSW, LMFT, LPC, Psychologist, RN). A minimum of 2 years of experience in substance use disorder treatment or inpatient mental health care, plus 3 years of post-degree clinical experience in private practice or other healthcare settings, is required. Intermediate proficiency in Microsoft Office Suite (Teams, Excel, PowerPoint, Outlook, Word) and exceptional oral, written, communication, and interpersonal skills are also necessary.

Responsibilities

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

Skills

Behavioral Health

Utilization Management

Care Coordination

Medical Services

Benefit Administration

Clinical Knowledge

Communication Skills

Critical Thinking

Substance Use Disorder Treatment

Inpatient Mental Health Care

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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