Behavioral Health UM Professional (Medicaid)

Location: Remote nationwide within the United States; Tuesday through Saturday, 8:00 AM to 5:00 PM Eastern Time. Less than 5% travel to hirify.global offices for meetings or training 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 serving Medicare and Medicaid members, families, individuals, military personnel, and communities.

What you will do

• Support behavioral health utilization management, care coordination, documentation, and benefit administration determinations.
• Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, and services.
• Coordinate and communicate with providers, members, and other parties to facilitate optimal care.
• Apply clinical knowledge, communication skills, and independent critical thinking in varied and occasionally ambiguous situations.

Requirements

• Bachelor’s degree in Nursing or a master’s degree in Social Work, Counseling, Psychology, or a related behavioral health discipline.
• At least 3 years of post-degree behavioral health clinical experience providing direct patient care.
• Active, unrestricted licensure as an LCSW, LMSW-ACP, LPC, active compact-license RN, or another behavioral health professional license recognized by applicable state regulations.
• Ability to work remotely from within the United States on an Eastern Time schedule.
• Dedicated workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds to protect member PHI and HIPAA information.

Nice to have

• Experience in managed care and Medicaid.
• Behavioral health utilization management review experience, including medical necessity determinations using MCG, ASAM, or InterQual.
• Experience with behavioral change methodologies, health promotion, coaching, or wellness initiatives.
• Bilingual English and Spanish proficiency, including the ability to speak, read, write, interpret, and explain documents in Spanish.

Culture & Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability and life insurance.
• Remote work with occasional office travel for training or meetings.