Supervisor, Utilization Management – Behavioral Health
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Job Description
Behavioral health utilization management supervisor at Humana, coordinating care determinations and supervising clinical associates. Supporting members through Humana’s healthcare and insurance services.
Responsibilities:
- Support the coordination, documentation, and communication of medical services and/or benefit administration determinations
- Interpret criteria, policies, and procedures using clinical knowledge and independent critical thinking
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Make decisions related to schedules, plans, and daily operations
- Perform escalated or complex work of a similar nature
- Supervise a group of support and technical associates
- Coordinate and provide day-to-day oversight to associates
- Ensure consistency in execution across the team
- Hold team members accountable for following established policies
- Collaborate with management and senior professionals/specialists on methods, techniques, and analytical approaches
Requirements:
- 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
- Current, valid, and unrestricted license: LMSW or LMSW-ACP, LPC or LMHC, LMFT, PhD/EdD, or RN
- Minimum of three (3) years of post-degree clinical experience in direct patient care
- 1 or more years of clinical supervisory experience
- Proficiency with MS Office products
- U.S. citizenship required for the Department of Defense contract
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
- Must not currently live in Puerto Rico
- Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Occasional travel to Humana offices for training or meetings
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