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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Behavioral Health Management, Care Coordination, and Case Management, with a strong focus on improving consumer experiences and navigating Medicaid and Medicare services. Proficient in data analysis and Microsoft Office applications, with a commitment to maintaining compliance with NCQA and HIPAA standards.
Highest-signal resume keywords
Unrestricted Registered Nurse (RN) LicenseBachelor’s Degree in Nursing (BSN) or Licensed Master Level Clinician5+ Years of Behavioral Health Professional Experience2+ Years of Care Coordination/Case Management ExperienceCertified Case Manager (CCM)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health ManagementCare CoordinationData AnalysisCase ManagementClinical Acute Care Experience
Soft Skills
LeadershipCommunicationProblem-Solving
Tools & Technologies
Microsoft Office ApplicationsWordExcelPowerPoint
Certifications & Qualifications
Certified Case Manager (CCM)
Industry Keywords
MedicaidMedicareNCQAManaged CareHIPAA
About the role
Key responsibilities & impact- Lead teams of nurses and behavioral health professionals responsible for care management
- Oversee assessment and evaluation of members’ behavioral health needs and requirements
- Guide members and families toward appropriate care and wellbeing resources
- Make decisions on resources, approaches, and tactical operations for departmental projects and initiatives
- Work cross-departmentally and conduct briefings and area meetings
- Maintain frequent contact with other department managers
- Identify and resolve barriers hindering effective care
- Apply department, segment, and organizational strategy and operating objectives
- Determine work methods and manage assignments with minimal direction
- Report to the Regional CM Associate Director
- Contribute to continuously improving consumer experiences
Requirements
What you’ll need- Unrestricted Registered Nurse (RN) license in the state of South Carolina
- Bachelor’s degree in Nursing (BSN) or a Licensed Master Level Clinician in psychology or social work (LCSW, LMSW, LMSW-ACP, CSW, LPC, LMFT)
- 5+ years of Behavioral Health professional experience
- 2+ years of management experience
- 2+ years of Care Coordination/Case Management experience
- Proficiency in analyzing and interpreting data trends
- Comprehensive knowledge of Microsoft Office applications, including Word, Excel and PowerPoint
- Experience working with Medicaid and/or Medicare enrollees to coordinate services, care needs, or benefits
- Experience with NCQA, including leading re-accreditation activities
- Experience with NCQA, state audit, and external quality review (EQR)
- Previous experience working in a managed care field
- 5+ years of management/supervisor-level experience
- 3+ years of clinical acute care experience in a behavioral health setting
- Certified Case Manager (CCM)
- Utilization management experience
- Ability to work Monday–Friday, 8:00 a.m.–5:00 p.m.
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Home internet with at least 25 Mbps download and 10 Mbps upload speed
Benefits
Comp & perks- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Bonus incentive plan
- Remote work
- Occasional travel to Humana offices for training or meetings
- Internet service requirements/support for home or hybrid employees