Behavioral Health UM Senior Professional - Remote

Profile

Description

The Senior Clinical Strategy and Practice Professional builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise The Senior Clinical Strategy and Practice Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Behavioral Health Professional has experience with requests for appropriate care and setting(s), guidelines and policies and completing medical necessity review and level of care review for requested services. Educate providers on utilization and medical management processes. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Develop model for BH UM with responsibility for implementing BH strategy in markets including how we address the BH levels of care (PHP, IOP, Residential, Inpt acute, etc).

Develop all BH-related policies, procedures, workflows, and training to support BH services for both PH and BH users;

Implement consistent practices across all markets for ASAM criteria, Mental Health First Aid, LOCUS, CANs, Trauma Informed Care and other BH-focused assessments and resources

Lead clinical implementation oversight and business owner for BH UM vendor (FOCUS) for UM and G&A decisions, and BH required surveys (SPH analytics for ECHO survey)

Develop training content for all BH related roles

Support market hiring of new BH leaders and staff, including onboarding experience and mentoring

Lead operational transition to integrated PH/BH model of care (eg, FL rebid opportunity to insource BH)

Liaison to BH Network team for developing VBP strategy for BH Providers

Stand up BH market pilots, innovations, etc. such as digital vendor implementation (eg, Workit. GoMo, Mystrength)

Policy and process development for specialized BH populations as defined in each state contract

Required Qualifications

Behavioral Health UM Senior Professional must meet one of the following:

Bachelor's degree in Nursing with a minimum of 3 years' experience in a behavioral health setting

Associate's degree in Nursing and 5 or more years in behavioral health setting

Master's degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university

Possess a current, valid, and unrestricted license from list: Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license

Behavioral Health UM Senior Professional must meet all of the following:

Proficient working with Microsoft Office Power Point, Word, Excel, Outlook

1 or more years of post-degree clinical experience in private practice or other patient care

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders

Proven ability of critical thinking, organization, written and verbal communication and problem solving skills.

Ability to manage multiple or competing priorities in a fast-paced environment.

Strong presentation, training, facilitation, and consensus building skills

Ability to provide subject matter expertise with all types of Behavioral Health Provider's, Provider load and claims payment

Must be available to work Monday - Friday 8:00 AM - 5:00 PM

Preferred Qualifications

3-5 years Medicaid Behavioral Health UM experience - using nationally recognized BH guidelines, including ASAM for SUD

1-2 years Health plan/Managed Care Organization experience

Experience with behavioral change, health promotion, coaching and wellness

Experience working with the older adult population

Knowledge of community health and social service agencies and additional community resources

Experience with creating workflows and job aids

Benefits

Benefit package that starts your 1st day of employment

Robust 401k plan through Charles Schwab.

Eligibility for associate wellness and rewards program

Opportunity to learn the industry and build professional career

Tuition Reimbursement & Student Loan Refinancing

Additional Information

Interview Process

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

Company info

Humana Inc.
Website : http://www.humana.com