Massachusetts Healthcare Jobs

MassHire JobQuest Logo

Job Information

Humana Utilization Management Behavioral Health Professional 2 in Boston, Massachusetts


The Utilization Management Behavioral Health Professional 2 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 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Other duties as assigned to the role.

Required Qualifications

  • Master's degree

  • Must possess a Current, Valid License in State of residence : Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Bachelor's or Master's level Registered Nurse (RN) or other professional license

  • Health professional with at least 3 plus years of clinical experience in a medical facility or office setting or other patient care settings

  • Experience with Utilization Review and/or Utilization Management

  • Comprehensive knowledge of Microsoft Office Suite to include Word and Excel

  • Ability to work an 8-hour shift, Monday through Friday 9:00am to 6:00pm Central Standard Time

  • Our Department of Defense Contract requires U.S. citizenship for this position

  • Successfully receive approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Work at Home Requirements

  • Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

  • Experience with TRICARE contracts and/or the military health care delivery system

  • Knowledge of ICD-10 codes

  • Experience with Medical necessity criteria application such as MCG and/or InterQual Criteria

  • Knowledge of TRICARE policies and programs

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours