[Hiring] Manager, Care Management Behavioral Health @Humana

Role Description

The Manager, Care Management Behavioral Health leads teams of nurses and behavioral health professionals responsible for care management. The Manager, Behavioral Health Care Management 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.

• Oversees the assessment and evaluation of members' behavioral health needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
• Makes decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Works cross departmentally and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
• Identifies and resolves barriers that hinder effective care.
• 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.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Qualifications

• Unrestricted Registered Nurse (RN) license in the state of South Carolina.
• Bachelor’s degree in Nursing (BSN) or a Licensed Master Level Clinician in the field of psychology or social work (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT).
• 5+ years of Behavioral Health professional experience.
• 2+ years of management experience.
• 2+ years Care Coordination/Case Management experience.
• Proficiency in analyzing and interpreting data trends.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
• Experience working with Medicaid and/or Medicare Enrollees to coordinate services, care needs, or benefits.
• Experience with NCQA to include leading re-accreditation activities.
• Experience with NCQA, state audit, and external quality review (EQR).

Requirements

• Previous experience working in a managed care field.
• 5+ years of management/supervisor level experience.
• 3+ years of clinical acute care experience in a behavioral health setting.
• Certified Case Manager (CCM).
• Utilization management experience.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities.

Additional Information

• Workstyle: This is a remote position.
• Location: South Carolina.
• Schedule: Monday - Friday from 8-5pm.
• Travel: Occasional travel as business needs.
• Scheduled Weekly Hours: 40.
• Pay Range: $78,400 - $107,800 per year.
• This job is eligible for a bonus incentive plan based upon company and/or individual performance.