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Job Details

Senior Utilization Management Behavioral Health Professional

Company name
Humana Inc.

Fort Wayne, IN, United States

Employment Type

Healthcare, Nursing, Bilingual

Posted on
Apr 11, 2023

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The Senior Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


The Senior Utilization Management Behavioral Health Professional uses 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Applicable Kentucky state licensure or a recognized COMPACT License in field of study without restriction.

Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), other professonal license with a Master's degree, or Registered Nurse (RN) with a Bachelor's degree in Nursing.

Minimum three, (3) , years post degree practice experience in Behavioral Health such as social work, psychology, or related health discipline from an accredited university

Minimum one, (1), year of post-degree clinical experience in private practice or other patient care

Minimum two , (2 ), years managed care experience

Expertise in clinical decision making as a Subject Matter Expert, SME, or as a Team Lead

Intermediate or better working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word, systems, platforms, and an ability to troubleshoot and resolve general technical difficulties

Exceptional oral and written, communication, and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.

Must be passionate about contributing to an organization focused on continuously improving consumer experience.

Workstyle: Remote Work at Home


Must reside in the state of Kentucky or within in a county contiguous state border: Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia

Schedule/Hours: Monday through Friday8:30 AM - 5:00 PM Eastern

Travel: Annual All Hands attendance one time yearly, usually in the spring, but is subject to change based on business needs.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Experience with utilization review process

Knowledge of substance use disorders and recovery 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

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.


Scheduled Weekly Hours


Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Company info

Humana Inc.
Website :

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