The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Key ...
The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Key ...
The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Key ...
The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Key ...
Utilization Management RN
Frankfort, KY · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... This role will report directly to the Manager, Utilization Management. Key Responsibilities:
Utilization Management RN
Frankfort, KY · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... This role will report directly to the Manager, Utilization Management. Key Responsibilities:
The Medical Director of Utilization Management/Care Management, reporting directly to the Chief Medical Officer, leads the UM and CM functions for Select Health from a clinical perspective, ensuring ...
The Medical Director of Utilization Management/Care Management, reporting directly to the Chief Medical Officer, leads the UM and CM functions for Select Health from a clinical perspective, ensuring ...
Utilization Coordinator PRN
Louisville, KY · On-site
$20/hr
... managed care organizations, local health professionals and agencies ... The Brook Hospital will strive to set the standard for excellence in the field of behavioral health ...
Utilization Coordinator PRN
Louisville, KY · On-site
$20/hr
... managed care organizations, local health professionals and agencies ... The Brook Hospital will strive to set the standard for excellence in the field of behavioral health ...
Please be advised that Elevance Health only accepts resumes for compensation from agencies that ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Please be advised that Elevance Health only accepts resumes for compensation from agencies that ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Please be advised that Elevance Health only accepts resumes for compensation from agencies that ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Please be advised that Elevance Health only accepts resumes for compensation from agencies that ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
Utilization Coordinator PRN
Louisville, KY · On-site
$20/hr
... managed care organizations, local health professionals and agencies ... The Brook Hospital will strive to set the standard for excellence in the field of behavioral health ...
Utilization Coordinator PRN
Louisville, KY · On-site
$20/hr
... managed care organizations, local health professionals and agencies ... The Brook Hospital will strive to set the standard for excellence in the field of behavioral health ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
About UofL Health: UofL Health is a fully integrated regional academic health system with five ... Case/Utilization Management (e.g., ACM, CCM, CMAC). Experience: Minimum seven years of UM/Case ...
Utilization Management Nurse RN
Louisville, KY · On-site
$75K - $82K/yr
Signature HealthCARE Signature HealthCARE is a family-based healthcare company offering integrated ... Utilization Management Nurses. * Coordinate internal and external health care team activities ...
Utilization Management Nurse RN
Louisville, KY · On-site
$75K - $82K/yr
Signature HealthCARE Signature HealthCARE is a family-based healthcare company offering integrated ... Utilization Management Nurses. * Coordinate internal and external health care team activities ...
Utilization Management Nurse RN
$75K - $82K/yr
... Utilization Management Nurses ... Coordinate internal and external health care team activities related to resident care, transitions ...
Quick apply
Utilization Management Nurse RN
$75K - $82K/yr
... Utilization Management Nurses ... Coordinate internal and external health care team activities related to resident care, transitions ...
Utilization Management Nurse RN
$75K - $82K/yr
... Utilization Management Nurses ... Coordinate internal and external health care team activities related to resident care, transitions ...
Quick apply
Utilization Management Nurse RN
$75K - $82K/yr
... Utilization Management Nurses ... Coordinate internal and external health care team activities related to resident care, transitions ...
Utilization Management Nurse RN
Louisville, KY · On-site
$75K - $82K/yr
Signature HealthCARE is a family-based healthcare company offering integrated services across ... Utilization Management Nurses. * Coordinate internal and external health care team activities ...
Utilization Management Nurse RN
Louisville, KY · On-site
$75K - $82K/yr
Signature HealthCARE is a family-based healthcare company offering integrated services across ... Utilization Management Nurses. * Coordinate internal and external health care team activities ...
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
Behavioral Health Supervisor
Madisonville, KY · On-site
$65K - $80K/yr
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
Behavioral Health Supervisor
Madisonville, KY · On-site
$65K - $80K/yr
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
Behavioral Health Supervisor
Madisonville, KY · On-site
$65K - $80K/yr
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
Behavioral Health Supervisor
Madisonville, KY · On-site
$65K - $80K/yr
Are you a dedicated and experienced Behavioral Health professional with a passion for helping ... PERFORMANCE MANAGEMENT: * Ensure teams meet performance measures in compliance. * Prioritize the ...
... of home health?utilization?management experience for a health plan?? * Effective telephonic and virtual communication skills?? * Comprehensive knowledge of Microsoft Word,?Outlook?and Excel?
... of home health?utilization?management experience for a health plan?? * Effective telephonic and virtual communication skills?? * Comprehensive knowledge of Microsoft Word,?Outlook?and Excel?
Behavioral Health Therapist
$52K - $69K/yr
The Behavioral Health Therapist provides behavioral health services, consultation, prevention ... case management as needed for currently enrolled students using evidence-based, ethical, and ...
Behavioral Health Therapist
$52K - $69K/yr
The Behavioral Health Therapist provides behavioral health services, consultation, prevention ... case management as needed for currently enrolled students using evidence-based, ethical, and ...
Behavioral Health Utilization Management information
See Kentucky salary details
$18.58 - $22.34
2% of jobs
$22.34 - $26.10
9% of jobs
$28.67 is the 25th percentile. Wages below this are outliers.
$26.10 - $29.86
21% of jobs
The median wage is $32.90 / hr.
$29.86 - $33.61
23% of jobs
$33.61 - $37.37
13% of jobs
$40.29 is the 75th percentile. Wages above this are outliers.
$37.37 - $41.13
10% of jobs
$41.13 - $44.89
8% of jobs
$44.89 - $48.65
5% of jobs
$48.65 - $52.40
5% of jobs
$52.40 - $56.16
2% of jobs
$56.16 - $59.92
2% of jobs
$18
$36
$59
How much do behavioral health utilization management jobs pay per hour?
What is the difference between Behavioral Health Utilization Management vs Behavioral Health Case Manager?
| Aspect | Behavioral Health Utilization Management | Behavioral Health Case Manager |
|---|---|---|
| Credentials | Licenses (e.g., RN, LCSW), certifications in utilization review | Licenses (e.g., LCSW, LPC), case management certifications |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, community clinics, outpatient facilities |
| Employer & Industry Usage | Health insurance providers, managed care organizations | Behavioral health agencies, hospitals, outpatient clinics |
Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.
What are common challenges in behavioral health utilization management and how are they addressed?
What is behavioral health utilization management?
What skills and qualifications are needed for behavioral health utilization management?

Other
Medical, Dental, Vision, Life, Retirement, PTO
This job post has expired today. Applications are no longer accepted.
Humana rating
8.0
Based on 265 frontline employees who took The Breakroom Quiz
163rd of 304 rated insurance
Job description
Become a part of our caring community
The 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 Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Key Responsibilities:
Clinical Review :
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Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity.
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Apply advanced evidence-based clinical guidelines in review decisions.
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Ensure compliance with accreditation, state, and federal regulations.
Communication and Coordination:
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Communicate with healthcare providers to obtain necessary clinical information and clarify requests.
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Coordinate with medical directors and interdisciplinary teams to support decision-making.
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Serve as a liaison between clinicians, internal departments, and providers.
Documentation and Reporting:
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Document all review findings and decisions in the clinical documentation system.
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Ensure timely and accurate documentation of prior authorization determinations.
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Support reporting initiatives and provide data for performance improvement projects.
Quality Assurance:
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Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions.
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Participate in and review audit findings to maintain high standards of service.
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Identify process improvement opportunities and contribute to performance improvement projects.
Education and Training:
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Educate providers and staff on prior authorization policies, criteria, and review processes.
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Provide mentorship and feedback to nonclinical staff to enhance workflow efficiency.
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Stay current with clinical best practices and regulatory changes.
Use your skills to make an impact
Required Qualifications
Candidate must be one of the following:
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Licensed Masters Clinical Social Worker (LCSW)
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Licensed Masters Social Worker (LMSW-ACP)
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Licensed Professional Counselor (LPC)
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Psychologist (PhD)
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Registered Nurse, licensed in IL, with 3 years of BH experience
Candidate must also have 1+ year of post-degree clinical experience in private practice or other patient care
Preferred Qualifications
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Experience with utilization review
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Experience with behavioral change, health promotion, coaching and wellness
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Certification in Case Management (CCM)
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Experience with Medicaid and Medicare policies and procedures
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Experience working with the older adult population
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Knowledge of payer policies, insurance companies and government health programs.
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Knowledge of community health and social service agencies and additional community resources
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Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
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
40
Pay 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 year
This 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.
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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
About Humana
Sourced by ZipRecruiter
Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Louisville, KY, US
Year founded
1961