[Remote] LMSW Behavioral Health Care Manager/Liaison at Humana

Michigan, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

LMSW, with current, valid social service license in the state of Michigan
Must reside in the state of Michigan and be able to drive to Wayne and Macomb counties
Ability to work effectively in a hybrid team setting of remote/in field with 10-15% travel
Minimum 2 years in an integrated care setting managing children and adult members with behavioral health needs

Responsibilities

Receive and review referrals from Humana Behavioral Health for members newly identified with behavioral health needs
Initiate appropriate service engagement with PIHP or other providers, ensuring prompt and accurate transition of care
Conduct follow-up outreach to members based on referral outcomes, including those where PIHP was unable to contact or denied services, to address behavioral health needs and prevent care gaps
Collaborate with Special Needs Plan Care Coordinators and other disciplines to address case management concerns, ensuring comprehensive and cohesive support for members across various departments
Act as the principal behavioral health resource for care management teams, facilitating seamless coordination between Humana Behavioral Health, PIHP, and internal stakeholders, and providing follow-up support as needed
Apply independent judgment to analyze complex behavioral health cases, determine optimal care strategies, and allocate resources effectively for positive member outcomes
Oversee follow-up activities based on referral dispositions (e.g., unable to contact, denied), ensuring that behavioral health and care management needs are addressed efficiently and responsively
Partner with Special Needs Plan Care Coordinators and interdisciplinary teams to identify and address holistic needs, promoting integrated care and improved member well-being
Exercise autonomous decision-making in carrying out job duties and related tasks, functioning effectively under minimal supervision
Travel to assist with community engagement and provider relations teams in providing a behavioral health perspective for meetings and events with community organizations, provider groups, and advisory councils
Build behavioral health strategies within the enterprise, business or segment to develop best practices and processes to improve outcomes for members
Assess and evaluate member needs and requirements to achieve and maintain optimal wellness state
Coordinate and employ a variety of strategies, approaches, and techniques to support the member’s psycho-social health needs as a member of the Interdisciplinary Care Team
Serve as the primary liaison between Prepaid Inpatient Health Plans (PIHP) and members already engaged in behavioral health services, facilitating timely service delivery, sharing updates, and resolving issues to support continuity of care
Support Humana members’ access to behavioral health services, provide member outreach and education related to behavioral health, assess risk, determine appropriate care in individual patient communities, and collaborate with providers, bridging gaps between Health Plan and PIHPs as well as clinicians across other Humana departments

Skills

Key technologies and capabilities for this role

LMSWBehavioral HealthCare ManagementCase ManagementMental HealthSubstance AbuseInterdisciplinary CareMember OutreachRisk AssessmentPIHP CoordinationMedicareMedicaid

Questions & Answers

Common questions about this position

Is this position remote or does it require office work?

This is a home-based position from a home office with 10-15% travel to Wayne or Macomb County for in-home visits with members. Candidates must reside in Michigan and be able to drive to those counties.

What qualifications or skills are required for this role?

The role requires an LMSW license and expertise in behavioral health strategies, including mental health and substance abuse services. Key skills include assessing member needs, coordinating interdisciplinary care, collaborating with PIHPs and providers, and applying independent judgment to complex cases.

What is the salary or compensation for this position?

This information is not specified in the job description.

What does the work environment or team structure look like?

The role involves working as part of an Interdisciplinary Care Team, collaborating with Special Needs Plan Care Coordinators, Humana Behavioral Health, PIHPs, providers, and clinicians across departments to support members.

What makes a strong candidate for this Behavioral Health Care Manager role?

Strong candidates will have LMSW licensure, experience in behavioral health case management, and the ability to reside in Michigan, travel locally, and independently handle complex cases involving member outreach, PIHP coordination, and interdisciplinary collaboration.

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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