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

Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management (Behavioral Health) applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department S.M.A.R.T goals.

• Supervises utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization, and referrals to care management.
• Oversees, monitors, orients and trains staff in the use of standard utilization management criteria including ASAM.
• Leads development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
• Collaborates with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
• Monitors and maintains staffing levels to meet care and service quality objectives.
• Conducts timely evaluations of direct reports and provide regular opportunities for professional development.
• Influences and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs.
• Collects and analyzes performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
• Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.

Use your skills to make an impact
 

Required Qualifications

• An active, unrestricted Virginia Registered Nurse (RN) or Behavioral Health clinician license such as a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT).
• Two (2) or more years of clinical experience working with the behavioral health populations preferably in an acute care, skilled or rehabilitation clinical setting.
• Two (2) years of leadership experience.
• Previous experience in utilization management. 
• Knowledge of ASAM, Interqual and/or Milliman (MCG) criteria.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook. 
• Ability to work independently under general instructions and with a team.

Preferred Qualifications

• Experience serving Medicaid populations.

Additional Information

• Workstyle & Travel: Remote but requires travel to our Humana Healthy Horizons location in Glen Allen, VA for collaboration and face to face meetings.
• Typical Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)
• Weekend On-Call Rotation: This position will require you to be on-call occasionally on weekends. While this may be rare, it will happen.

Work at Home Internet Statement

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.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making abi