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.

               

Job Description

The Manager, Utilization Management Behavioral Health (Medicaid) 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.
• Tracking, creating reports and presenting on utilization management trends with various stakeholders

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, and/or psychology, from an accredited university.
• Possess a current, valid, and unrestricted license in the state of Kentucky or compact state license. Such licenses are:
  • Licensed Clinical Social Worker (LCSW)  
  • Licensed Professional Counselor (LPCC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Registered Nurse (RN) with BSN
• 3 or more years of post-degree clinical experience in direct patient care required.
• 2 or more years of utilization management experience.
• 1 or more years of supervisory experience required.
• Proficiency with MS office products
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Must possess strong technical and analytical skills with ability to present UM metrics
• Strong communication skills including technical writing
• Must be available to work Monday – Friday 8:30-5:00 PM EST (Hours outside of this may be required but only due to Business needs)

Preferred Qualifications

• Experience working with Managed Care and/or Medicaid

 Additional Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
  
  At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  Satellite, cellular and microwave connection can be used only if approved by leadership
  Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

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 because he or she is a protected veteran. 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