About Humana


Job Category:

Member Quality & Financials - Utilization Management


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Utilization Management Behavioral Health Professional 2

Humana - Work At Home, Florida

Posted: 11/14/2018


Humana is seeking a Utilization Management Behavioral Health Professional 2: Post-Discharge Follow-Up. This associate will utilize behavioral health knowledge and skills to work with identified members to assess their care needs, assist in planning and implementing interventions to meet those needs, assist in coordinating services, and monitoring and evaluating the case management plan against the member’s personal health care goals.


The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills to:

• Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally 

• Assist members in achieving stability and improved well-being in their community

• Facilitate wrap-around planning for members who have had recent inpatient utilization

• Understand clinical program design, implementation, and management, monitoring and reporting

• Work collaboratively with other members of the Humana Interdisciplinary team

• Comply with performance and reporting standards as defined by Humana

• Complete additional responsibilities as deemed appropriate by Humana leadership


Required Qualifications

  • Master's degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university, or an associate's degree in nursing
  • Applicable State licensure in field of study. Such licenses are: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license
  • Minimum of 3 years of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience

Preferred Qualifications

  • Experience with utilization review process
  • Experience with behavioral change, health promotion, coaching and wellness
  • Experience working with the older adult population
  • Knowledge of community health and social service agencies and additional community resources
  • Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish

Scheduled Weekly Hours


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