Manager, Utilization Management Behavioral Health
DescriptionThe Manager, 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 Manager, Utilization Management Behavioral Health 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.
- The Manager, 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 resources, approach, and tactical operations for projects and initiatives involving own departmental area.
- Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
- An active Licensed Registered Nurse (RN), a licensed Master’s Level Social Worker (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT) or a Psychologist (PhD/EdD) in the State of Oklahoma without restrictions.
- Bachelor’s Degree in Nursing or a Master's Degree in a Behavioral Health related field such as Social Work, Counseling, and/or Psychology.
- 3+ years of post-degree clinical experience in direct patient care.
- 2+ years of case management and/or rehabilitative counseling experience.
- 2+ years of clinical supervisory experience.
- Previous experience in utilization management.
- Ability to work independently under general instructions and with a team.
- Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
- Experienced with Milliman or Interqual criteria.
Health benefits effective day 1. 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:
- 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.
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:
- 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.
- 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.
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.
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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$84,600.00 - $105,800.00
Scheduled Weekly Hours40