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Key skills for this role
Ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
Identify and resolve barriers that hinder effective care.
Plan and implement interventions to meet care needs.
Coordinate services, monitor, and evaluate the case management plan against the member's personal goals.
Ensure the patient is progressing towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with members, and active care planning.
Assess and evaluate enrollee's needs via telephonic and face-to-face assessments and evaluations, to coordinate services and address enrollee needs.
Assist enrollee to remediate immediate and acute gaps in care and access.
Assist enrollee with filing grievances and appeals.
Provide information to enrollee related to MCO requirements, services, and benefits.
Provide enrollee with information or referrals to community resources.
Guide members/families towards resources appropriate for their care. Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member's care as appropriate and required by our comprehensive contract.
Visit to hospitals- travel up to 25%.
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Workstyle: This is a remote work from home position.
Travel: Up to 25% travel may be needed to see members in the hospital within a 50-mile radius.
Typical Workdays and Hours: Operating hours are Monday - Friday 8:00 AM - 7:00 PM CST but core hours for this position are primarily Monday – Friday, 8:00 AM – 5:00 PM CST. May need to be flexible with work schedule based on business needs.
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Health insurance and care services provider.
Visit company websiteJobs and hiring trendsUSD 53700-72600 yearly / year
Full-time
Entry · 1+ years experience
Remote
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