Medicaid/Dual Eligible - Behavioral Healthcare Consultant

Role: Medicaid/Dual Eligible - Behavioral Healthcare Consultant
Assignment: Senior Products
Location: Louisville, KY - National City Tower/WAH - Midwest/East Coast
This role will be focused on directing our efforts to enhance our care management model and work with our network of Behavioral Health providers and vendors to serve the dual eligible population.
As Humana?s Medicaid Dual Eligible business grows, this role is designed to include a broader scope of program leadership for product and market development, , and membership growth and retention.
Key Role Objectives
Develop an overview of current Behavioral Health care management strategies and models, and work with the Health Care Delivery and Clinical Process teams to create a market approach that aligns with Humana?s brand, commitment to quality outcomes and related market strategies.
Develop educational resources and executive presentations to address organization?s need to understand the challenges and opportunities of the Behavioral Health market. Create learning, development and coaching opportunities to transfer Behavioral Health network development capabilities across the National Contracting organization.
Work closely with the Medicaid Operations Leader s to insure end-to-end provider claim and call quality, enhancing ease of use and participating in external provider education program training and development activities. Build and nurture positive relationships with the provider network.
Design and implement programs around quality products and innovative behavioral health care management programs, with a focus on medical expense reduction opportunities. Identify gaps in network composition and services and assist in the recruitment, contracting and credentialing of new providers.
Develop administrative processes and guidelines for the enrollment of beneficiaries into Medicaid Managed Long Term Care and Dual Demonstration programs , including the approval of care management services, and compliance within all areas of the business
Maintain current status of all state state-mandated Managed Long Term Care and Dual Demonstration initiatives, including regulatory considerations, roll-out timelines, and managed care market competition for Behavioral Health .
Maintain on-going relationships with strategic provider partners and vendors and serve as the key contact for the resolution of provider issues as they are identified.
As a Humana leader, champion efforts to create a working environment where productivity can be sustained and accomplished and where innovation and personal growth are encouraged and realized.
The successful candidate will bring broad managed care experience to this role with progressive Medicare and Medicaid knowledge and experience in behavioral health field. Prior experience developing strategies and successfully building Behavioral Health networks is desired. .
A strong understanding of how Behavioral Health providers function and operate is fundamental to this role, including the breadth of community services that support mental health
Experience participating in ?end-to-end? contract negotiation process through closure for different Behavioral Health providers, as well as delegated specialty services.
Experience in health plan finance and the compensation arrangements between health plans and providers, including plan funding, risk management and provider reimbursement. Must possess ability to identify health service expenses and implement cost control mechanisms within contracts.
Prior operational leadership experience in sales, finance, health services, and/or medical management; demonstrated ability to partner across functions to create and deploy win/win strategies.
Role Essentials:
Minimum of a Bachelor?s degree in a behavioral health field or an RN degree with at least 2 years of Behavorial Health Experience
Requires an active unrestricted state professional license:
Licensed Clinical Social Worker; or
Licensed Marriage & Family Therapist; or
Licensed Clinical Professional Counselor; or
Licensed Psychologist
Registered Nurse
Minimum of 5 years of experience in the Behavioral health field unless Registered Nurse with 2 years Experience in Behavioral Health
Experience in mental health and substance abuse services delivery system
Knowledge of principles and practices of public mental health service delivery systems
Proficiency in Microsoft applications
Have the ability to travel 50% and reside close to major airport
Role Desirables:
Bi-lingual English/Spanish language skills
Familiarity with Prior Authorization process and requirement
Demonstrated competence in clinical care management, strong leadership and organization skills; interpretation of State and federal laws and regulations relevant to the mental health program area
Knowledge of evidence-based, best and promising practice methods and procedures and strong customer service orientation
Ability to effectively plan, assign, direct and evaluate the work of subordinates
Excellent verbal, written, and interpersonal communication skills
At least 2 years Supervisory experience
Extensive skills in working with the public
Prefer candidates who reside in the Midwest or East Coast due to travel requirements
Job Market Management
Title: Medicaid/Dual Eligible - Behavioral Healthcare Consultant
Location: KY-Louisville
Other Locations: US-AL-Birmingham, US-GA-Atlanta, US-TN-Chattanooga, US-Illinois-Chicago, US-West Virginia-Beckley, US-Massachusetts-Boston, US-North Carolina-Asheville, US-Pennsylvania-Philadelphia, US-Maine-Portland, US-OH-Canton, US-Virginia-Norfolk
Requisition ID: 166764 ff4d20d087d1458a9f82540ee381a575

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