Behavioral Health Strategy Lead

Michigan, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must reside in Michigan, Illinois, Indiana, Ohio, or Wisconsin and hold an active, unrestricted Michigan license as a Licensed Master Social Worker, Licensed Clinical Social Worker, Licensed Professional Counselor, Licensed Marriage and Family Therapist, or Licensed Addiction Counselor. A minimum of three years of behavioral health experience and intermediate to advanced proficiency in Microsoft Office Suite (Outlook, PowerPoint, Word, Excel) are required. Demonstrated experience in managing large-scale programs, problem-solving in complex environments, strong influencing and process improvement skills, and effective communication and presentation abilities to senior leaders are also necessary.

Responsibilities

The Behavioral Health Strategy Lead will coordinate and bridge gaps between Humana and Prepaid Inpatient Health Plans (PIHPs), acting as a subject matter expert for Humana's market teams and the primary contact for Humana's HIDE SNP Plus population with PIHPs. Responsibilities include participating in interdisciplinary care teams, assessing customer needs, managing behavioral health concerns related to PIHPs, ensuring compliance with accreditation, contract, and CMS requirements, and collaborating with quality partners to meet quality targets. The role involves reviewing integration performance, network adequacy, and improvement projects, assisting with community engagement and provider relations, and collaborating on referral tracking and service access metrics. Additionally, the lead will establish and maintain contact listings for PIHPs and participate in key committees and reviews related to behavioral health care delivery.

Skills

Behavioral Health

Strategy

Liaison

Health Plan Operations

Subject Matter Expertise

CMS Compliance

Quality Improvement

Provider Relations

Community Engagement

Interdisciplinary Care Teams

Performance Monitoring

Service Access Metrics

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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