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%

Work at Home Guidance 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

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.

• 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 ou