Humana Health Horizons in Louisiana is seeking a Behavioral Health (BH) Children’s System Administrator (Care Management Behavioral Health Lead) who will advise on program features to reach members and drive outcomes for those with severe BH needs age 18 and younger across Louisiana. The BH Children’s System Administrator (Care Management Behavioral Health Lead) will coordinate and collaborate with internal and external partners to assist enrollees and their families in achieving treatment goals, while helping them access appropriate community care and support services.

Responsibilities

• Coordinates health plan activities to improve BH outcomes for Humana Louisiana Medicaid enrollees ages 0-18 with severe BH needs.
• Acts as an advocate for enrollees, ensuring they receive needed services and materials in a timely and appropriate manner.
• Advises case management and other clinical associates serving children and youth with severe behavioral health needs to ensure timely, culturally-competent, and appropriate delivery of care, education, and support to the child and their family.
• Evaluates the overall effectiveness of care plans and recommend strategic modifications to improve outcomes.
• Reviews and compares utilization patterns to identify opportunities to align with evidence-based practices (EBPs).
• Ensures adherence to and compliance with all federal and state statutes.
• Influence and assist market and corporate leadership in strategic planning to achieve BH care management outcomes for enrollees ages 0-18.
• Establishes positive, ongoing relationships with relevant medical, community, and social supports stakeholders.
• Reviews psychiatric and community referral patterns to identify possible training or education opportunities for Care Management staff.
• Participates in ongoing conversations with providers to determine acuity of mental health concerns, barriers, and progress; coordinate continuity of services and ensure an ongoing focus on holistic, trauma-informed care.
• Collaborates with the Coordinated System of Care (CSoC) Governance Board and Louisiana Department of Health (LDH).
• Manages OCDD, DCFS, LDOE, LGE and IDD liaisons.

Required Qualifications

• Must reside in the state of Louisiana
• Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Physicians (Psychiatrists), Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
• Minimum seven (7) years of experience and expertise in the specialized BH needs of children with severe BH challenges and their families.
• Minimum three (3) years of experience with delivering or managing EBPs and best practices for children and youth, including experience within system of care and wraparound environments.
• Prior experience with child serving systems.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Work at Home Requirements

• 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.
• Humana will provide Home or Hybrid Home/Office associates 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.

Preferred Qualifications

• Experience working with one or more of the following populations: children and youth involved in the Juvenile Justice (OJJ) or child welfare system (DCFS); children diagnosed with Autism Spectrum Disorder or other developmental disabilities; children and adolescents undergoing complex psychiatric and substance use disorder (SUD) treatment.
• Experience writing and developing health plan BH clinical policy and guidelines.
• Experience providing training, mentoring, and/or educational support to plan members.
• Ability to speak at LDH meetings.

Additional Information

• Workstyle: Remote
• Travel: Up to 15% in-state travel mainly to meetings in Baton Rouge, LA with LDH and team engagement meetings in Metairie, LA
• Typical Work Day & Hours: Monday – Friday; 8:00am – 5:00pm CST.
• Direct Reports: Up to 2 associates.
• Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

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Scheduled Weekly Hours

40