Care Management Support Assistant

San Antonio, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

The candidate must be a U.S. citizen due to Department of Defense contract requirements. A high school diploma or GED is required, and some college coursework is preferred. Experience in a customer service or administrative support role, preferably in a healthcare or managed care setting, is beneficial. Familiarity with TRICARE, Autism Spectrum Disorder (ASD), or care management principles is a plus.

Responsibilities

The Care Management Support Assistant will support the Autism Service Navigator by coordinating services for TRICARE beneficiaries with ASD. This includes conducting non-clinical outreach, researching resources, connecting families with support groups, monitoring referral reports for outreach prioritization, and directing incoming calls. Responsibilities also involve assisting with care coordination, identifying community resources, interfacing with providers for issue resolution, assisting with new referrals to ensure access to care, and tracking outcome measure completion. The role includes providing telephonic customer service, answering questions about referrals and authorizations, resolving beneficiary issues, and facilitating transitions for provisional paperwork while ensuring accurate documentation and effective communication with other departments.

Skills

Care Coordination

Resource Research

Community Outreach

Provider Relations

Claims Inquiry

Enrollment Issues

Access to Care

Referral Management

Communication

Problem-Solving

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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