利用管理行为健康专业人员
Utilization Management Behavioral Health Professional
成为我们关怀社区的一员
利用管理行为健康专业人员运用行为健康知识和技能，支持医疗服务质量及/或福利管理决定的协调、记录和沟通。利用管理行为健康专业人员2的工作任务多样，经常需要对适当的行动方案进行解释和独立判断。该职位将向行为健康经理汇报，并成为行为健康UM团队的一员。
在此职位中，您将：
- 运用临床知识、沟通技巧和独立批判性思维，解读标准、政策和程序，为成员提供最佳且最合适的治疗、护理或服务。
- 与提供者、成员或其他相关方协调和沟通，以促进最佳的护理和治疗。
- 了解部门、业务单元和组织的战略和运营目标，包括它们与相关领域的联系。
- 遵守既定的指南/流程
利用您的技能产生影响
所需资格
- 持有路易斯安那州独立执照的硕士水平临床工作者（例如：持证临床社会工作者（LCSW）、持证专业咨询师（LPC）、持证婚姻与家庭治疗师（LMFT）、持证成瘾咨询师（LAC））
- 1年以上管理护理经验
- 熟悉MCG和美国成瘾医学协会标准
- 熟练使用电子信息系统和Microsoft Office工具（Word、Outlook、Excel），以有效记录、沟通和与内部合作伙伴及成员协作。
- 展现出扎实的键盘操作和网页导航技能，能够提供清晰的叙述性记录，并通过卓越的沟通和人际交往能力建立信任关系。
- 必须能够每周工作40小时，周一至周五上午8:00至下午5:00 CST，可能需要加班，并需承担周末及值班轮班以满足业务需求
- 必须居住在路易斯安那州并在该州内工作
优先资格
- 在急性或门诊行为健康环境中具有2年直接护理经验
- 有利用管理或事先授权经验
- 有行为改变、健康促进、辅导和健康方面的经验
- 有为Medicare、Medicaid、TANF和/或CHIP人群服务的经验
查看英文原文
Become a part of our caring community
The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.This position will report to the Behavioral Health Manager and be part of the Behavioral Health UM Team.
In this role you will:
- Apply clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
- Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Follows established guidelines/procedures
Use your skills to make an impact
Required Qualifications
- Master's level clinician with independent licensure in the state of Louisiana (i.e. Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapists (LMFTs) Licensed Addiction Counselors (LACs)
- 1+ year of managed care experience
- Familiarity with MCG and American Society of Addiction Medicine Criteria
- Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members.
- Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities.
- Must be available to work 40-hour work week Monday – Friday 8:00-5:00 PM CST, potential for overtime with an expectation to cover a weekend and on-call rotation to meet business needs
- Must reside in Louisiana and perform work within the state
Preferred Qualifications
- 2 years of direct care experience in an acute or outpatient behavioral health setting
- Experience with Utilization Management or Prior Authorization
- Experience with behavioral change, health promotion, coaching and wellness
- Experience serving Medicare, Medicaid, TANF, and/or CHIP populations.
- Knowledge of community health and social service agencies and additional community resources
Additional Information
Location: Must reside and perform work in Louisiana
Training: 6-week training process
Hours: Must be able to work a 40-hour work week, Monday through Friday 8:00 AM to 5:00 PM Central Time, weekend rotations are required (the work week will be flexed) and over-time may be requested to meet business needs
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
Work at Home Requirements: 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 suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas