UM Licensed Behavioral Health Professional (LCSW, LMSW-ACP, LPC, RN)

Become a part of our caring community

Humana Healthy Horizons is looking for a Utilization Management Behavioral Health Professional 2 who uses behavioral health knowledge to support the coordination, documentation, and communication of medical services or benefit administration determinations. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

You will be part of a caring community at Humana. We're proud of our Louisville roots and, as we've grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you're working from home, from the field, from our offices, or from somewhere in between—you'll feel welcome here.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

• Use clinical knowledge, towards interpreting criteria and procedures to provide the best treatment, care or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed.
• Follow established guidelines/procedures.

Required Qualifications

• Bachelor's degree from an accredited institution.
• 1+ year of post-degree clinical experience in a private practice or patient care setting.
• Active, unrestricted licensure in one of the following disciplines:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Masters Social Worker (LMSW-ACP)
  • Licensed Professional Counselor (LPC)
  • Registered Nurse (RN)
  • Or another behavioral health professional license recognized by applicable state regulations.

Preferred Qualifications

• Master's degree from an accredited institution.
• 1+ year of experience working in a managed care environment.
• Experience utilizing ASAM, MCG, or InterQual clinical guidelines.
• Demonstrated subject matter expertise in utilization review for inpatient and outpatient behavioral health services.
• Experience in behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual proficiency in English and Spanish.

Additional Information

• Schedule/Time Zone: Monday through Friday, 8:00 AM – 5:00 PM with flexibility to work overtime/weekends as needed.
• Work Location: US
• Work Style: Remote
• Internet Requirements: Minimum 25 Mbps download / 10 Mbps upload speed required.
• Interview Format: Uses HireVue technology.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40
• Pay Range: $65,000 - $88,600 per year (eligible for bonus incentive).
• Application Deadline: 06-04-2026

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.

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.