Utilization Management Behavioral Health Professional - Remote

Overview

The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.

In Short

• Perform utilization management activities for assigned areas.
• Ensure compliance with contract requirements, policies, and procedures.
• Conduct initial and ongoing treatment reviews with documentation in MSR.
• Use clinical knowledge to interpret criteria and complex issues.
• Coordinate communication with providers and beneficiaries for optimal care.
• Collaborate with Humana operations to improve processes.
• Strategize with leaders to improve policy and case management outcomes.
• Understand risk management procedures and organizational strategy.
• Work from home with specific internet requirements.
• Occasional travel to Humana's offices for training or meetings may be required.

Requirements

• U.S. citizenship required.
• BCBA Certification.
• 3+ years as a Board-Certified Behavior Analyst.
• 3+ years of ABA experience with ASD.
• Proficiency in Microsoft Office programs.
• Ability to work an 8-hour shift between 8 AM - 6 PM Eastern time.
• Overtime, weekends, and holidays may be required.
• Prior experience with TRICARE Autism Care Demonstration preferred.
• Knowledge of CPT codes and outcome measure assessments preferred.
• Military experience is a plus.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and other opportunities.