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Manager, Utilization Management (Behavioral Health)


Become a part of our caring community and help us put health first

Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management (Behavioral Health) applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department S.M.A.R.T goals.

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  • Supervises utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization, and referrals to care management.
  • Oversees, monitors, orients and trains staff in the use of standard utilization management criteria including ASAM.
  • Leads development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  • Collaborates with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
  • Monitors and maintains staffing levels to meet care and service quality objectives.
  • Conducts timely evaluations of direct reports and provide regular opportunities for professional development.
  • Influences and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs.
  • Collects and analyzes performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  • Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.

Use your skills to make an impact

Required Qualifications

  • An active, unrestricted Virginia Registered Nurse (RN) or Behavioral Health clinician license such as a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT).
  • Two (2) or more years of clinical experience working with the behavioral health populations preferably in an acute care, skilled or rehabilitation clinical setting.
  • Two (2) years of leadership experience.
  • Previous experience in utilization management.
  • Knowledge of ASAM, Interqual and/or Milliman (MCG) criteria.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.

Preferred Qualifications

  • Experience serving Medicaid populations.

Additional Information

  • Workstyle & Travel: Remote but requires travel to our Humana Healthy Horizons location in Glen Allen, VA for collaboration and face to face meetings.
  • Typical Workdays & Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST)
  • Weekend On-Call Rotation: This position will require you to be on-call occasionally on weekends. While this may be rare, it will happen.

Work at Home Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours


Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$76,800 - $105,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Job ID: humana-R-338338
Employment Type: Full Time