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.
Licensed Behavioral Health Utilization Management Clinician at Humana — Louisiana Remote
Provide behavioral health utilization management for Humana members through clinical reviews, care coordination, and benefit determination support. This remote Louisiana position is suited to licensed nurses and behavioral health professionals.
Description
- Coordinate, document, and communicate medical services and benefit administration determinations
- Apply behavioral health criteria, policies, and procedures to assess appropriate treatment and services
- Coordinate care and communicate with providers, members, and other involved parties
- Use independent clinical judgment to determine appropriate next steps
- Follow established procedures and guidelines with limited supervision
- Conduct medical necessity reviews using MCG, ASAM, InterQual, and related criteria
- Work Tuesday through Saturday from 8:00 AM to 5:00 PM Central Time after training and precepting
- Complete weekday training Monday through Friday from 8:00 AM to 5:00 PM Central Time
- Travel occasionally to Humana offices for training or business meetings
Requirements
- Hold either a multistate-compact Registered Nurse license or a Louisiana professional license backed by a master's degree in a behavioral health-related field, with no disciplinary history
- Qualifying licenses include LCSW, LMSW, LPC, LMFT, LAC, and Licensed Psychologist
- Have at least three years of post-degree clinical experience in direct patient care
- Have at least three years of behavioral health experience
- Demonstrate proficiency with Microsoft Office
- Navigate multiple systems and platforms effectively
- Troubleshoot and resolve technical issues in a remote work environment
- Maintain a dedicated workspace with minimal interruptions to protect member PHI and HIPAA information
- Provide internet service with at least 25 Mbps download and 10 Mbps upload speeds
- Accommodate an Eastern Time schedule, occasional weekends, and holidays
- Preferred: experience in behavioral health utilization management and medical necessity reviews using MCG, ASAM, or InterQual
- Preferred: managed care or Medicaid experience
- Preferred: health plan experience
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-term and long-term disability coverage
- Life insurance
- Remote work arrangement
- Limited travel for office meetings, typically one to two times annually as business needs require