Join our compassionate team and play a vital role in prioritizing health! As a Telephonic Behavioral Health Care Manager, you will be an essential member of the Humana Military Case Management team, utilizing a holistic approach for Behavioral Health Case Management throughout the full care continuum. Your role will involve personally connecting with beneficiaries to address their behavioral health needs and conditions identified through referrals, predictive analytics, or diagnosis triggers. You will assist them in managing immediate care needs, adhering to treatment plans, and developing effective coping strategies. In this position, you will assess, plan, coordinate, implement, monitor, and evaluate the care needs of TRICARE beneficiaries over the phone. Your objective is to empower each beneficiary's self-care capabilities to enhance their quality of life and achieve positive clinical outcomes. As a part of our Case Management team, you will be the primary point of contact for beneficiaries, coordinating all activities within the clinical spectrum. This includes working closely with Military Treatment Facilities (MTF), various Care Management programs (like Disease Management and Utilization Management), and healthcare providers to create an integrated care plan that addresses all beneficiary needs. You will also be responsible for documenting interventions and outcomes within the Case Management program, maintaining your efforts within your professional scope of practice. Key Responsibilities: Conduct comprehensive assessments and design personalized care plans for TRICARE beneficiaries, collaborating closely with their physicians and care teams. Oversee and approve medically necessary care in accordance with TRICARE guidelines to fulfill beneficiaries' health needs. Offer telephonic care guidance and support to beneficiaries and their families, ensuring education and coordination as per the established care plan. Identify gaps in care and assess eligibility for assistance or additional services in partnership with Humana Government Business. Utilize Motivational Interviewing and solution-focused strategies in all communications. Recognize and address Social Determinants of Health needs and community resources available to beneficiaries. Respect and maintain beneficiaries' privacy, confidentiality, advocacy, and uphold ethical and regulatory standards at all times. Adhere to organizational policies and performance standards as outlined in URAC, TRICARE Operations Manual (TOM), and Defense Health Agency (DHA) directives. Required Qualifications: A valid, unrestricted license as a Mental Health/Behavioral Health Professional (such as LCSW, LPC, LMHC, LMSW, or Clinical Psychologist) in your state of residency. Minimum of 3 years of clinical experience, including managed care experience. Willingness to achieve Certified Care Manager (CCM) certification within your first year of employment. Experience in mental health crisis intervention. Strong proficiency in Microsoft Office Suite, particularly Word, Excel, OneNote, and Outlook. Exceptional verbal and written communication skills. Demonstrated organizational abilities, and capacity to manage multiple tasks effectively. U.S. citizenship is required due to Department of Defense contract obligations. Ability to obtain government security clearance (via National Background Investigation Services). Please note that Humana Government Business is unable to hire candidates residing in Puerto Rico due to government contract restrictions. Preferred Qualifications: Active certification as a Certified Care Manager (CCM). Experience in acute inpatient hospital case management. Knowledge of medical and behavioral health case management programs. Military experience is a plus. Familiarity with TRICARE policies and military healthcare systems. Experience with motivational interviewing techniques. Bilingual in Spanish and English is a desirable asset. Additional Information: Work Environment: This is a remote position. Schedule: Monday to Friday, requiring an 8-hour shift between 8:00 a.m. - 6:00 p.m. EST. Training: Mandatory training for the first four weeks from 8:00 a.m. - 5:00 p.m. EST. Remote Work Requirements: Internet service must have a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; a wired, cable, or DSL connection is preferred. Satellite, cellular, or microwave connections may only be used with prior approval. Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly stipend for internet expenses. Humana will supply essential phone and computer equipment for the role. Work from a dedicated space free from interruptions to ensure the protection of member PHI and HIPAA compliance. Interview Process: We will utilize innovative interview technology, HireVue, to streamline our hiring process and connect with you effectively. Travel Requirements: Occasional travel to Humana offices for training or meetings may be needed despite this being a remote position. Weekly Hours: 40 Compensation: The estimated salary range for this full-time position is $59,300 - $80,900 per year, depending on geographic location and individual qualifications. This role is eligible for a bonus incentive plan based on both company and individual performance. Benefits: Humana offers robust benefits that foster overall well-being, including medical, dental, and vision coverage, retirement savings plans, generous paid time off policies, disability insurance, and more. Application Deadline: 02-12-2026 About Humana: Humana Inc. (NYSE: HUM) prioritizes health and well-being for our teams, customers, and communities. Our comprehensive insurance and healthcare services empower millions of individuals to achieve optimal health outcomes. Equal Opportunity Employer: Humana fosters a workplace free from discrimination, ensuring equal opportunities for all applicants and employees based on valid job requirements without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.
