Utilization Management Behavioral Health Professional

Location: Remote Louisiana; must reside in Louisiana and perform work within the state. Occasional travel to hirify.global offices for training or meetings may be required.

Salary: $65,000–$88,600 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company providing services to Medicare, Medicaid, military, individual, and community populations.

What you will do

• Interpret behavioral health criteria, policies, and procedures to support appropriate treatment, care, and service determinations.
• Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
• Document medical services and benefit administration determinations in electronic information systems.
• Apply independent critical thinking to varied utilization management cases and determine appropriate courses of action.
• Follow department, segment, and organizational guidelines while supporting operational objectives.

Requirements

• Master’s-level clinician with independent Louisiana licensure, such as LCSW, LPC, LMFT, or LAC.
• At least 1 year of managed care experience.
• Familiarity with MCG and American Society of Addiction Medicine criteria.
• Proficiency with electronic information systems and Microsoft Word, Outlook, and Excel.
• Strong keyboard, web navigation, written documentation, communication, and interpersonal skills.
• Availability for a 40-hour Monday–Friday schedule from 8:00 AM to 5:00 PM CST, with possible overtime, weekend coverage, and on-call rotation.

Nice to have

• Two years of direct care experience in acute or outpatient behavioral health.
• Experience with utilization management or prior authorization.
• Experience with behavioral change, health promotion, coaching, and wellness.
• Experience serving Medicare, Medicaid, TANF, or CHIP populations.
• Knowledge of community health, social service agencies, and community resources.

Culture & Benefits

• Remote work from a dedicated space that protects member PHI and HIPAA information.
• Home internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.
• Medical, dental, and vision coverage.
• 401(k), paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability, life insurance, and other well-being benefits.