Remote Director Utilization Management Behavioral Health, RN

Humana

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Location: Tampa, FL
Location Type: Tampa – Remote
Additional Location: IL; IN; KY; LA; OH; OK; SC; WI;
Schedule: Full_time
Req: R-318415

Description

 

The Director, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Director, Utilization Management Behavioral Health requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

You will be part of a caring community at Humana.
When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

 

Responsibilities

 

The Director, Utilization Management Behavioral Health

  • Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members
  • Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment
  • Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance
  • Implements and manages health care utilization, and operationalizes utilization management initiatives.
  • Ensures program compliance and identifies opportunities to improve the member and provider experience, and quality measures.
  • Supports clinical cost management, implementation, and utilization management of initiatives, operationalizes implementation of new products, maintaining meeting cadence and reporting with the state, and operationalizes integration initiatives.
  • Oversees the development and execution of behavioral health policies, procedures, and guidelines; assists in developing clinical management guidelines.
  • Ensures behavioral health management activities are contracted, reviewed and reported.
  • Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
  • Support Hires, trains, coaches, counsels, and evaluates performance of direct and indirect staff
  • Provides input into functions strategy

 

This is a remote position

#LI-Remote

#LI-MH1

               

Required Qualifications

  • Master’s Degree in a behavioral health related field such as social work, counseling, and/or psychology, from an accredited university
  • 5 or more years of management experience
  • Possess a current, valid, and unrestricted clinical license. Such licenses are: Licensed Masters Social Worker (LICSW or LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), PhD/EdD, or Registered Nurse (RN) with behavioral health experience and Compact License
  • 3 or more years of post-degree clinical experience in direct patient care required.
  • 2 or more years of case management and/or rehabilitative counseling experience required. Certified or certified-eligible case manager required.
  • 3 or more years experience in a team leadership or supervisory position.
  • Comprehensive knowledge of all Microsoft Office applications and strong database software proficiency
  • Progressive experience in the managed care
  • Strategic thinking and business planning capabilities; organized and detail-oriented
  • Excellent written and verbal communication skills
  • Demonstrated presentation skills
  • Willingness to manage and prioritize diverse projects & reports
  • Able to give direction and make sound business decisions.
  • Knowledge of front and backend operations
  • Ability to exercise sound judgement and engage in ethical behavior
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Previous experience in Medicaid managed care and utilization management
  • Experience managing Medicaid benefits related to covered services and the strategy, practice and execution in multiple states
  • Ability to work Eastern Time Zone hours

Additional Information

About Humana

Your growth is what drives Humana forward.

  • When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you.
  • This is a place where our nurses influence the C-suite.
  • Where software engineers change lives.
  • Where every associate can build a professional path where they learn and thrive.
  • Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
  • Because finding new ways to put health first—for our members and patients and
    our associates alike—is what we do.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
  • Associates 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 associates 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, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

 

Scheduled Weekly Hours

 

40