Humana
Humana
Humana is a healthcare and health insurance company focused on improving health outcomes for individuals, communities, and the broader healthcare system. Its work includes Medicare Advantage HMO, PPO, and PFFS plans serving populations such as seniors and military members. Humana also emphasizes an inclusive workplace built around belonging, mutual respect, and opportunities for employees to contribute to the company’s health-focused mission.

Humana Behavioral Health Utilization Management Clinician - Louisiana Remote

Humana seeks a Louisiana-based behavioral health utilization management clinician for a full-time remote role. The position supports clinical reviews, care coordination, and benefit determinations and is open to qualified RNs and licensed behavioral health professionals.

Description

  • Coordinate, document, and communicate medical services and benefit administration determinations
  • Interpret behavioral health criteria, policies, and procedures to assess appropriate treatment, care, and services
  • Communicate with providers, members, and other stakeholders to support effective care and treatment
  • Use clinical expertise, clear communication, and independent critical thinking in daily decisions
  • Align work with department, segment, and organizational strategies and operating objectives
  • Determine work methods independently when situations are occasionally ambiguous and guidance is limited
  • Perform duties in accordance with established guidelines and procedures
  • Work remotely, with occasional travel to Humana offices for training or meetings

Requirements

  • Must live in Louisiana
  • Hold either a Licensed Registered Nurse credential under the Multi-State Compact or a Louisiana professional license tied to a master's degree in social work, counseling, psychology, or another behavioral health field, with no disciplinary history
  • Candidates using the behavioral-health master's-degree pathway must also hold an independent Kentucky license
  • Accepted licenses include LCSW, LMSW, LPC, LMFT, LAC, and Licensed Psychologist
  • At least three years of post-degree clinical experience providing direct patient care
  • At least three years of behavioral health experience
  • Working knowledge of Microsoft Office, multiple systems and platforms, and basic remote technical troubleshooting
  • Availability Monday through Friday, 8:00 AM to 5:00 PM Central Time, with flexibility for Eastern Time scheduling and occasional weekends and holidays
  • Internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload
  • Dedicated, interruption-free workspace suitable for protecting member PHI and HIPAA information
  • Preferred experience with behavioral health utilization management using MCG, ASAM, or InterQual criteria
  • Managed care or Medicaid experience preferred
  • Health plan experience preferred

Benefits

  • Eligibility for a bonus incentive plan tied to company and/or individual performance
  • Medical, dental, and vision coverage
  • 401(k) retirement savings plan
  • Paid time off
  • Company and personal holidays
  • Paid parental and caregiver leave
  • Short- and long-term disability coverage
  • Life insurance
  • Employee-provided internet service for remote work
  • Occasional travel to Humana offices for training or meetings

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