Behavioral Health Clinical Advisor - Remote United States

Profile

Description

The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) will audit CPT (Current Procedural Terminology) codes to ensure correct billing under TOM (TRICARE Operations Manual) policies in accordance with the ACD (Autism Care Demonstration).

Responsibilities

The Behavioral Health Clinical Advisor (Care Manager, Telephonic Behavior Health 2) role will be responsible for the administration and monitoring of the Autism Care Demonstration (ACD) which includes:

Coordination of services for ABA Therapy, benefits provided under the Exceptional Family Member Plan (EFMP).

Auditing for quality and clinical compliance, and case management.

Serve as a Humana Military liaison to TRICARE beneficiaries' personal care managers and providers.

Employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues.

Identifies and resolves barriers that hinder effective care.

Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.

May create member care plans.

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Follows established guidelines/procedures.

Required Qualifications

Possess a current, valid, and unrestricted clinical license in the state in which they reside. Such licenses are: Licensed Masters Social Worker (LMSW-ACP), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN), BCBA (Board Certified Behavior Analyst or other professional license.

Minimum of 1 year of post-degree clinical experience in private practice or other patient care.

Our Department of Defense Contract requires U.S. citizenship for this position.

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).

Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.

Preferred Qualifications

Experience with Microsoft Office products for business presentations including; Word, Excel, PowerPoint, Visio, Project, etc.

Previous experiences in auditing.

Must be willing to obtain Certified Case Manager Certification within 1 year of hire.

Direct or indirect Military experience.

Additional Information

The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Work Days/Hours : Monday - Friday; 8:00am - 5:00pm or 9:00am - 6:00pm Eastern Standard Time(EST) . The department is flexible with work schedules.

Training/Training Days & Hours: 2 weeks; Monday - Friday , 8:00am - 4:00pm Eastern Standard Time (EST).

I nterview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, 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 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