Manager, Care Management Behavioral Health

Humana; United States; Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Remote position

Competitive benefits

Job summary

Humana is seeking a Manager, Care Management Behavioral Health to lead teams of nurses and behavioral health professionals in care management across states served. Responsibilities include assessing members' behavioral health needs, coordinating resources, and working cross-departmentally to improve consumer experiences.

Remote position with South Carolina location, 40-hour weeks. Competitive benefits and a base pay range of $78,400 to $107,800 per year, with bonus eligibility.

Qualifications

• Unrestricted RN license in South Carolina.
• BSN or Licensed Master Level Clinician credentials.
• 5+ years Behavioral Health professional experience.
• 2+ years management experience.
• 2+ years Care Coordination/Case Management experience.
• Proficiency in analyzing and interpreting data trends.
• MS Office applications (Word, Excel, PowerPoint).
• Experience with Medicaid/Medicare enrollees.
• Experience with NCQA accreditation activities.
• Experience with NCQA, state audit, and EQR.

Responsibilities

• Oversee assessment and evaluation of members’ behavioral health needs to guide care.
• Decide resources, approach, and tactics for departmental projects.
• Collaborate across departments; conduct briefings with managers.
• Identify and resolve barriers hindering effective care.
• Align work with department and organizational strategy and goals.
• Make independent decisions with minimal direction.

Skills

Data trend analysis

Microsoft Office

Care coordination

Team leadership

Stakeholder communication

Education

RN license (SC)

BSN or LCSW/LMSW/LMSW-ACP/CSW/LPC/LMFT

Tools

NCQA

Medicaid/Medicare experience

Job description

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)

PreferredQualifications:

• 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 year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.