Humana

Care Coach (HRA - Field to Telephonic)

Illinois, United States

Not SpecifiedCompensation
Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree in social sciences, social work, human services, or a related field, or an active, unrestricted Licensed Practical Nurse (LPN) license in Illinois with one year of experience assessing and providing services to the elderly. Applicants must reside in Illinois or within a 10-mile radius of Illinois in a bordering state. A minimum of one year of experience in healthcare and/or case management, and one year of experience working with Medicare and Medicaid recipients, long-term care services, Home and Community-Based Services (HCBS), and/or managed care organizations is required. Intermediate to advanced computer skills, including proficiency in Microsoft Word, Excel, and Outlook, and the ability to use various electronic information applications/software programs, including electronic medical records, are necessary. Exceptional communication and interpersonal skills are essential, as is the ability to build rapport with diverse individuals. The role requires the ability to travel locally to meet face-to-face with members, community partners, and care teams, and candidates must be willing to undergo TB screening.

Responsibilities

Care Coaches will assess and evaluate members' needs and requirements to achieve optimal wellness by guiding them towards and facilitating interaction with appropriate resources. This involves conducting telephonic and face-to-face assessments, coordinating services, and addressing immediate care gaps. Responsibilities include assisting enrollees with filing grievances and appeals, providing information on MCO requirements, services, and benefits, and referring them to community resources. Care Coaches will ensure members receive services in the least restrictive setting, identify and resolve barriers to effective care, and plan and implement interventions. They will coordinate services, monitor case management plans, and ensure member progress towards desired outcomes by continuously monitoring patient care. The role involves facilitating interactions with other payer sources, providers, and interdisciplinary teams.

Skills

Medicaid
Care Coordination
Case Management
Assessment
Intervention Planning
Community Resources
Grievance and Appeals
Communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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