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The Manager, Utilization Management Behavioral Health uses 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. You will apply advanced technical knowledge to solve moderately complex problems. You will receive assignments in the form of goals and determines approach, resources, schedules, and goals. 

The Manager, Utilization Management Behavioral Health uses clinical knowledge and independent critical thinking skills. You use these skills towards interpreting criteria and procedures. The goal is to provide the best and most appropriate treatment, care, or services for members. Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You typically relate decisions to resources, approach, and tactical operations for projects involving own departmental area. Requires cross departmental collaboration, and will conduct briefings and area meetings; maintain 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, and/or psychology, from an accredited university.
• Hold a current, valid, and unrestricted license in the state of Virginia. Such licenses are: Licensed Masters Social Worker (LMSW or LMSW-ACP). They also include Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), PhD/EdD, or Registered Nurse (RN).
• 3 or more years of post-degree clinical experience in direct patient care required.

Preferred Qualifications

• 2 or more years of utilization management behavioral health.
• 1 or more years of clinical supervisory experience required, including personnel management.

Additional Information

Potential for travel, weekend work based on business needs

Work at Home Criteria

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:

• We recommend at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; we suggest a wireless, wired cable or DSL connection.
• Satellite, cellular and microwave connection leadership approves only if used.
• We will provide employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the our 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 use an interviewing technology called HireVue to enhance our hiring. Modern Hire allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

SSN Alert

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 [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

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. 

$86,300 – $118,700 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, volunteer time off, 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 at Humana.com and at CenterWell.com. 

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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.