Utilization Management Behavioral Health Professional

Become a part of our caring community Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. You will work on assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action. Utilize 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. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed. Follow established guidelines/procedures. Use your skills to make an impact Required Qualifications Bachelor’s degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without disciplinary action. Such licenses are: Licensed Masters Clinical Social Worker ( LCSW) , Licensed Marriage and Family Therapist (LMFT) , Licensed Pro