RogersRecruiter Since 2001
the smart solution for Rogers jobs

Behavioral Health Medicaid Market Development Advisor

Company: Humana
Location: Rogers
Posted on: February 15, 2020

Job Description:

Description The Market Development Advisor provides oversight and administration of the Behavioral Health benefits to support Medicaid health plans relative to Medicaid product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial. The position serves as the resident BH subject matter expert available to all teams as necessary. Responsibilities The Market Development Advisor serves as the primary resource on regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicaid performance benchmarks. Maintains relationships with regulators within a region. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Duties and Responsibilities + Work in collaboration with UM and CM Directors/Managers in coordinating clinical supervisory role for UM/CM of BH cases as part of the broader integrated medical and BH care coordination team. Operational supervision and direct report responsibilities to remain with UM/CM Directors/Managers. Will oversee, manage and participate in BH rounds and case conferences as well as co-coordinate integrated BH/medical rounds and case conferences with the UM/CM Directors/Managers. Provide cross-departmental assistance specific to management of BH services such as: assist in training and management of BH UM and CM and integrated BH/medical care coordination; work with Provider Services to review and insure network adequacy, provider satisfaction, specialty contracting, etc.; help Claims to insure appropriate configuration and payment for BH services; help train and advise Member Services regarding BH benefits and appropriate referral processes, assist Compliance and Government Contracting in interpretation and adherence to all BH regulatory and contractual obligations. + Support CMO in coordination of necessary BH Medical Director role. In collaboration with the UM/CM Directors/Managers be responsible for coordination of BH Medical Director role in staffing cases, leading rounds, attending integrated care case conferences, training, etc. + Provide collaboration and oversight of specific BH HEDIS measures, BH NCQA requirements, provider/member satisfaction and any other quality improvement or state audit activities specific to BH in conjunction with Market Quality team. + Work collaboratively with UM/CM Directors/Managers to ensure appropriate inclusion of BH specific functions, roles and responsibilities, work flows, etc. within broader P & Ps and SOPs regarding general UM/CM. + Participate in interviewing of candidates for all Behavioral Health positions; participate in final hiring decisions in collaboration with UM/CM Directors/Managers + Serve as community liaison to BH advocacy groups, non-contracted community partners (e.g., community mental health centers), service organizations, etc., specific to BH. Assist in community outreach activities to improve community awareness of Humanas involvement in BH service management and integrated whole person health promotion. + Provide feedback as appropriate in performance and professional development to assist UM/CM Directors/Managers in performance evaluations of BH specialty staff. + Assist senior management as requested to review, evaluate and potentially develop/implement new business opportunites, service expansion or other special projects specific to BH. Serve as DRI when requested for any such ventures. + Communicate state and federal regulatory changes related to behavioral health benefits to CMO or VP/HCS + Accountability to Humana Corporate BH Leadeship to ensure alignment with the Humanas vision for integrated behavioral health enterprise-wide + Represent the health plan with state-wide stakeholders and officials on all issues relating to the provision of behavioral health benefits + Other duties as assigned Knowledge, Skills and Abilities + Understanding of all elements of the full continuum of care spectrum of BH services (e.g., inpatient and outpatient services, community support services, substance abuse treatment programming, etc.). + Familiarity of treatment modalities and programs across ages inclusive of child and adult specialty programming + Excellent verbal and written communication skills + Ability to abide by Humanas policies + Ability to maintain attendance to support required quality and quantity of work + Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) + Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Qualifications: + Two years in managed behavioral healthcare setting + Five years in clinical practice + Three years of supervisory or management experience in a behavioral health setting + Unrestricted Masters or doctoral level licensure as a behavioral health professional (PhD, PsyD, LCPC, LPC, LMFT, LCSW) + Current or recent experience with Medicaid programs Preferred Qualifications: + Five years in managed behavioral healthcare setting with at least 2 years clinical management experience + More than five years of experience in clinical practice + Unrestricted Doctoral level licensure as a behavioral health clinician (PhD, PsyD) + Business development experience, specifically involving RFPs Additional Information + This is a work at home opportunity and can be in any location. Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact to validate the request. Categories - Financial Services Posted: 2020-01-24 Expires: 2020-02-23 Humana

Keywords: Humana, Rogers , Behavioral Health Medicaid Market Development Advisor, Healthcare , Rogers, Arkansas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Travel Nurse RN - Labor and Delivery - $1,711 per week
Description: trustaff is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Fort Smith, Arkansas: br br br ul br li Specialty: Labor and Delivery br li Discipline: RN br li (more...)
Company: NurseFly Travel Nursing
Location: Fort Smith
Posted on: 02/21/2020

Travel Nurse - Cath Lab RN - Fort Smith, AR
Description: Travel Cardiac Cath Lab RN Keep those hearts beating while making over 1,650 take home in Fort Smith, AR Job Details Estimated 1,650 take home a week 8H shifts 13-week contract Job Requirements AR (more...)
Company: General Healthcare Resources - Travel Nursing
Location: Fort Smith
Posted on: 02/21/2020

Travel Speech Therapist/SLP, SALT LAKE CITY, UT
Description: Travel Speech Therapist/SLP SALT LAKE CITY, UT br Location: SALT LAKE CITY, UT br Start Date: 2/18/2020 br Shift Details: 8H Days 7:00 AM-3:00 PM br 40 hours per week br Length: 13 weeks
Company: Triage Staffing
Location: Springfield
Posted on: 02/21/2020


General Psychiatrist
Description: Job Description Overview Valley Behavioral Health Full-Time Psychiatrist Needed Valley Behavioral Health Adult In-patient B/C or B/E required 114 Beds Residential, Inpatient, Outpatient and Day
Company: Acadia Healthcare
Location: Fort Smith
Posted on: 02/21/2020

Travel Speech Therapist/SLP, LAWTON, OK
Description: Travel Speech Therapist/SLP LAWTON, OK br Location: LAWTON, OK br Start Date: 2/18/2020 br Shift Details: 8H Days 7:00 AM-3:00 PM br 40 hours per week br Length: 13 weeks Apply for
Company: Triage Staffing
Location: Broken Arrow
Posted on: 02/21/2020

Travel Nurse RN - Telemetry - $1,794 per week
Description: Advantis Medical is seeking a travel nurse RN Telemetry for a travel nursing job in Springfield, Missouri: br br br ul br li Specialty: Telemetry br li Discipline: RN br li Start
Company: NurseFly Travel Nursing
Location: Springfield
Posted on: 02/21/2020

RN / Emergency Nursing / Missouri / Travel / Registered Nurse - ER Job
Description: JOB REQUIREMENTS Emergency Room ER/ED Registered Nurse Travel Job Emergency Room nurses provide care for patients with various types if illness or trauma requiring emergency attention. The ER RN must (more...)
Company: GIFTED Healthcare
Location: Springfield
Posted on: 02/21/2020

Administrator of Home Health
Description: The Administrator of Home Care is responsible for the advancement of the home health division. This position is an integral member of the leadership team and establishes personal and professional credibility (more...)
Company: INTEGRITY HOME CARE + HOSPICE - SPRINGFIELD - INTE
Location: Springfield
Posted on: 02/21/2020

RN Registered Nurse Circulator - Operating Room (St. John Broken Arrow)
Description: We Are Hiring RN Registered Nurse Circulator Department: Operating RoomSchedule: Full Time Days 6:30am - 5:00pm - 4 10 hour shifts late stay is possible -NO WEEKENDS. NO CALL. - NO HOLIDAYS Location: (more...)
Company: Ascension, C95
Location: Broken Arrow
Posted on: 02/21/2020

Travel Nurse RN - Progressive Care Unit - $1,516 per week
Description: trustaff is seeking a travel nurse RN Progressive Care Unit for a travel nursing job in Springfield, Missouri: br br br ul br li Specialty: Progressive Care Unit br li Discipline: RN (more...)
Company: NurseFly
Location: Springfield
Posted on: 02/21/2020

Log In or Create An Account

Get the latest Arkansas jobs by following @recnetAR on Twitter!

Rogers RSS job feeds