Licensed Behavioral Health Utilization Management Professional (RN, SW, Counseling, Psychology)

Location: Remote Louisiana, United States. Training is Monday through Friday, 8:00 AM–5:00 PM Central Time; the regular schedule is Tuesday through Saturday, 8:00 AM–5:00 PM Central Time, with flexibility for Eastern Time hours, occasional weekends, holidays, and limited office travel.

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

Company

hirify.global is a U.S. healthcare and health insurance company serving Medicare, Medicaid, military, individual, family, and community members.

What you will do

• Coordinate, document, and communicate behavioral health medical services and benefit administration determinations.
• Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, and services.
• Perform independent utilization management decision-making in varied and occasionally ambiguous situations.
• Communicate with providers, members, and other parties to facilitate optimal care and treatment.
• Work across multiple systems and platforms in a remote environment and troubleshoot technical issues.

Requirements

• One qualifying license is required: a Multi-State Compact Registered Nurse license, or a master's degree in social work, counseling, or psychology with a professional Louisiana license.
• Qualifying licenses include LCSW, LMSW, LPC, LMFT, LAC, or Licensed Psychologist; no history of disciplinary action is permitted.
• At least 3 years of post-degree clinical experience in direct patient care and 3 years of behavioral health experience.
• Proficiency with Microsoft Office, multiple systems and platforms, and general technical troubleshooting.
• A dedicated, interruption-free workspace and internet service with at least 25 Mbps download and 10 Mbps upload are required to protect member PHI and HIPAA information.

Nice to have

• Behavioral health utilization management experience, including medical necessity reviews using MCG, ASAM, or InterQual.
• Managed care or Medicaid experience.
• Health plan experience.
• An independent Kentucky license.

Culture & Benefits

• Remote work with less than 5% travel and occasional travel to hirify.global offices for training or meetings.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan, paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and additional wellness and healthcare benefits.
• 40 scheduled hours per week.