Humana is a healthcare company serving Medicare and Medicaid members through insurance and healthcare services. The Care Coordinator, Initiation Team, supports newly enrolled Illinois Medicaid members by conducting health risk assessments, identifying care needs and barriers, and connecting enrollees with healthcare, social, and community resources. The role also coordinates and monitors care plans, facilitates access to services, and requires extensive local travel.
Visit Medicaid enrollees in their homes, Assisted Living Facilities, and/or Long-Term Care Facilities and other care settings – 75% local travel
Ensure enrollees 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, monitors, and evaluates the case management plan against the enrollee's personal goals
Ensure the enrollee is progressing towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with members, and active care planning
Assess and evaluates 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 enrollees/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 enrollee’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)
**Must reside in the state of Illinois.**
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
* **Workstyle/Travel:** This is a Field position that requires 75% travel in the field to visit members
* **Schedule:** Monday - Friday 8am - 5pm CST but open to flexible work schedule. Possibility of working additional hours 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
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required
Preferred
Benefits
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
Flexible work schedule
Humana is a health insurance provider for individuals, families, and businesses.
