Utilization Management Behavioral Health Professional 2 - Remote Oklahoma

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Job Information
Humana
Utilization Management Behavioral Health Professional 2 - Remote, Oklahoma
in
Ponca City
Oklahoma
Description
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. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Utilization Management Behavioral Health Professional 2 completes telephonic and paper reviews to obtain sufficient clinical information. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge and independent critical thinking skills to apply the appropriate criteria to make a medical necessity determination.
Complete telephonic and/or paper reviews with behavioral health facilities and behavioral health providers.
Reviews discharge plans.
Coordinates with Care Coordination and Case Management.
Prepares cases for clinical rounds with Medical Directors.
Required Qualifications
Licensed Registered Nurse (RN) or a licensed Masters Level Social Worker (LMSW or LMSW-ACP, LCSW, LPC, LMFT, PHD or other professional licenses) in the State of Oklahoma with no disciplinary action.
Minimum of three (3) years of post-degree clinical experience in direct patient care. 
Three (3) years or more of Behavioral Health experience.
Proficiency with Microsoft Office products such as Word, Excel and Outlook.
Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Must reside in Oklahoma; Occasional travel to office for staff meetings, training, etc.
Preferred Qualifications
Experience with utilization review process.
Experience with behavioral change, health promotion, coaching and wellness.
Knowledge of community health and social service agencies and additional community resources.
Bilingual preferred (Spanish, Native Tribal, Vietnamese or other).
Additional Information
Benefits
: Effective on the 1st day of employment; Medical, Dental & Vision, Competitive 401k match, Paid Time Off (PTO) accruals, Tuition Reimbursement, Parental Leave & much more.....
Typical Days/Hours
: Monday - Friday; 8:00am - 5:00pm Central Standard Time (CST).
Travel:
Occasional travel to our Oklahoma City office location for staff meetings, training, etc.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

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