Humana is a healthcare company serving Medicare and Medicaid members through insurance and healthcare services. The Care Coordinator supports Illinois Medicaid members by assessing their needs, developing care plans, coordinating services, and connecting them with healthcare and community resources. The role involves home and facility visits, monitoring outcomes, and addressing barriers to care.
Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long-Term Care Facilities and other care settings – 75%-90% local travel
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 and/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
Qualification
Required
Bachelor's degree in social sciences, social work, human services, or a related field
Unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one (1) year experience conducting comprehensive assessments and provision of formal service for the elderly
Licensed Professional Counselor (LPC)
Licensed Social Worker (LSW)
1+ years of experience in health care and/or case management
1+ years of experience with Medicare & Medicaid recipients and/or long-term care and/or Home and Community based services and/or working with managed care organizations
Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook
Experience using a variety of electronic information applications/software programs including electronic medical records
valid state driver's license
personal vehicle liability insurance
Preferred
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off, including paid time off, company and personal holidays, paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Humana is a health insurance provider for individuals, families, and businesses.
