Utilization Management Behavioral Health Professional

Must meet one of the following: Active unrestricted registered nurse license in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced compact licensure, (eNLC) Active unrestricted LCSW, LPC, LMFT, or LCP, Licensed Clinical Psychologist to practice as a health professional within the state of Virginia Must meet all of the following: Minimum one, (1) year of post-degree clinical experience in private practice or other clinical patient care setting Minimum one, (1) year of managed care experience Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment. Ability to work independently under general instructions and with a team Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills Preferred Qualifications: Experience with utilization review process Experience with behavioral change, health promotion, coaching and wellness Knowledge of community health and social service agencies and additional community resources Additional Information: Workstyle: Remote work at Home Location: Location for Registered Nurse: must reside in the state of Virginia or reside in a state participating in the enhanced nurse compact licensure, (eNLC) Location for Behavioral Health Licensed Professional: must be licensed in the state of Virginia Schedule: Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs Travel: Less than 5% to attend onsite market meetings as business needs Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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