Manager, Care Management Behavioral Health

Humana Inc; Northern (KY); Hybrid; USD 78,000 - 108,000; Full time

Job summary

Humana Inc in South Carolina seeks a Manager, Care Management Behavioral Health to lead nurses and behavioral health professionals delivering care management for members. This remote role requires SC RN license or equivalent, BSN or master's level clinician, and strong data analysis and NCQA experience.

You'll drive cross‑department collaboration, remove barriers to care, and align with organizational strategies while guiding teams to optimal wellness outcomes.

Qualifications

• Unrestricted RN license in SC or equivalent licensure.
• BSN or licensed master level clinician in psychology or social work.
• 5+ years behavioral health experience.
• 2+ years of management experience.
• 2+ years care coordination/case management experience.
• Proficient in data analysis and Microsoft Office.
• Experience with Medicaid/Medicare and NCQA coordination/audits.

Responsibilities

• Oversees assessment and evaluation of members' behavioral health needs.
• Guides members/families toward resources for care and wellbeing.
• Makes decisions on resources, approach, and tactical operations for projects.
• Works cross departmentally; conducts briefings and area meetings.
• Identifies and resolves barriers to effective care; aligns with strategy.

Skills

Behavioral health experience

Management experience

Care coordination

Data analysis

Microsoft Office

Medicaid/Medicare experience

NCQA familiarity

Utilization management

Education

BSN

Licensed Master Level Clinician (LCSW/LMSW/LMSW-ACP/CSW/LPC/LMFT)

Tools

MS Office

Job description

## Manager, Care Management Behavioral HealthApply: Remote South Carolina: Full time: Posted Today: R-429843# **Become a part of our caring community**Why Humana? At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future. Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths. About Humana Healthy Horizons Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health. Report to the Regional CM Associate Director.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.**Position Responsibilities:*** 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# **Use your skills to make an impact****Required 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) **Preferred Qualifications:** * 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 **Additional Information****Workstyle:** This is a remote position**Location:** South Carolina**Schedule:** Monday - Friday from 8-5pm**Travel:** Occasional travel as business needs Work at Home 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**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.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.