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The Manager, Behavioral Health Utilization Management 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 resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross-different departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

_Detailed Responsibilities include:_

Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for supporting **_Behavioral Health Outpatient services_** including:

+ Leading a team of Behavioral Health Utilization Management Clinicians and support staff responsible for reviewing and processing clinical authorizations

+ Supporting development of IT business requirements and training content for administering utilization management process in Humana’s clinical systems;

+ Assist in reviewing, analyzing and reporting out on Utilization Management reporting requirements to assure operational oversight and address state reporting requirements for supporting Kentucky Medicaid.

+ Implementing processes and procedures to ensure alignment with contractual and regulatory expectations as well as training staff on these expectations.

+ Assuring compliance with state timeframes for turnaround times on authorization requests and delivery of Utilization Management services.

+ Support provider inquiry regarding Utilization Management processes and best practices as well as provision of data and discussion related to provider practices to ensure alignment.

Use your skills to make an impact

Required Qualifications

+ 2+ years of experience in a Supervisory or Managerial role overseeing staff

+ 2 + years of experience working in Utilization Management processing clinical authorizations

+ Licensed Registered Nurse (RN) in the state of Kentucky (or compact licensure) or Masters Level Independently Licensed Clinician (i.e., LCSW, LPCC, LMFT) with no disciplinary action

+ 3+ years clinical Behavioral Health experience preferably in outpatient care in a clinical setting

+ Intermediate to advanced Microsoft Office Products (Word, Excel, Teams, Outlook & Power Point)

+ Experience presenting ideas and reports to Senior Leadership

+ Ability to work independently under general instructions and with a team

+ Must reside and perform work in the state of Kentucky or contiguous county in nearby state, and occasionally report to the office for meetings

+ Potential on call duties weekends on a rotating basis

Preferred Qualifications

+ Health Plan experience

+ Prior Medicare / Medicaid experience

+ Bilingual is a plus

+ Experience with addressing state reporting requirements for Medicaid

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 required.

+ Satellite, cellular and microwave connection can be used only if approved by leadership.

+ Employees 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 employees 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 for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

**Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be** asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at 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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.