Humana

Care Management Behavioral Health Professional

Florida, United States

Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Position Overview

  • Location Type: Home (Remote with occasional office visits)
  • Job Type: Full time
  • Salary: Not specified

Humana Healthy Horizons in Florida is seeking a Care Management Behavioral Health Professional to join their caring community. This role focuses on providing behavioral health services to patients dealing with issues such as addiction, abuse, or mental illness, particularly those engaged in Applied Behavioral Analysis (ABA) services within the case management program.

Responsibilities

  • Outreach to members/guardians to engage them in the Care Management Program.
  • Screen members for social determinants of health (SDOH), medical, and other identified needs to close gaps in care.
  • Provide members with community resources.
  • Attend case conferences with treatment providers to address clinical progress.
  • Work with members/families to ensure all gaps related to ABA and member needs are closed.
  • Screen and assist with other needs such as Speech/OT/PT, Psychological, and Neuropsychological testing.
  • Employ a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.
  • Identify and resolve barriers that hinder effective care.
  • Ensure patient progress towards desired outcomes through continuous monitoring via assessments and/or evaluations.
  • May create member care plans.
  • Understand department, segment, and organizational strategy and operating objectives.
  • Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction and receiving guidance where needed.
  • Follow established guidelines/procedures.

Requirements

  • Bachelor’s degree in nursing, social work, or a behavioral health-related field OR 3+ years of experience working with individuals receiving ABA services.
  • Registered Behavior Technician with 2+ years’ experience.
  • AHCA Level II Background Check is required.

Preferred Qualifications

  • Experience working in managed care.
  • BCBA (Board Certified Behavioral Analyst).
  • Care Management/Care Coordination experience.
  • RN or LPN with experience working with children with autism spectrum disorder.
  • Master’s - LCSW, LMHC with experience working with children with autism spectrum disorder.

Additional Information

  • Work Location: Florida (preferred to reside in Florida)
  • Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm EST.
  • Workstyle: Home (Remote but will use Humana office space on an as-needed basis for collaboration and other face-to-face needs).
  • Internet Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended (wireless, wired cable, or DSL connection suggested; satellite, cellular, and microwave connections may be used if approved by leadership).
  • California, Illinois, Montana, or South Dakota Residents: Will be provided a bi-weekly payment for internet expenses.
  • Equipment: Humana will provide appropriate telephone equipment.
  • Work Environment: Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Interview Technology: HireVue will be used as part of the hiring process.

Skills

Behavioral Health
Case Management
ABA (Applied Behavioral Analysis)
Social Determinants of Health (SDOH)
Community Resources
Care Planning
Assessment and Evaluation
Barrier Resolution
Psycho-social Health Management
Coordination with Treatment Providers
Screening and Outreach
Testing (Speech/OT/PT, Psychological, Neuropsychological)

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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