Job Description

Become a part of our caring community and help us put health first
 

The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, Utilization Management Behavioral Health 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. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Use your skills to make an impact
 

Required Qualifications

• Degree in Nursing or a Master's degree in a behavioral health-related field, such as Social Work, Counseling, or Psychology from an accredited university

• Licensed Registered Nurse or a licensed Master’s Level Behavioral Health Clinician in the state of residence with no disciplinary action

• 3 or more years of post-degree clinical experience in direct patient care required.

• 2 or more years of case management and/or rehabilitative counseling experience required. Certified or certified-eligible case manager required.

• 1 or more years of clinical supervisory, team lead, project management, lead experience required.

• Proficient with MS Office, navigating multiple systems and platforms and general technical skills to troubleshoot and resolve within a remote environment.

Workstyle: Remote Work at Home

Location:  Prefer Humana Medicaid Market

Schedule:  Monday through Friday 8:00-5:00 PM Eastern Time

• Flexibility to accommodate Eastern Time Schedule to meet business needs

Travel:  Travel for meetings and training as needed. Travel expected to be no more than 15%

Preferred Qualifications

• Behavioral Health UM experience, performing medical necessity reviews against criteria such as MCG, ASAM, InterQual

• Experience as a manger which may include hiring, training, coaching, and up to termination.

  JOB IS FROM: nursingjobs.siteVIEW

• Care, Medicaid

• Health plan experience

• Certified Case Manager, CCM

Additional Information:

Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert Statement

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Benefits Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1, Paid time off, holidays, volunteer time and jury duty pay, Recognition pay, 401(k) retirement savings plan with employer match,
Tuition assistance, Scholarships for eligible dependents, Parental and caregiver leave, Employee charity matching program, Network Resource Groups (NRGs), and Career development opportunities.

#L1-Remote

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.

 

$76,800 - $105,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.