Care Management Support Assistant

Kentucky, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must be U.S. citizens and able to obtain interim government security clearance. A minimum of 3 years of experience in a clinic, hospital case management, managed care, or healthcare setting is required, involving provider interaction, patient/provider phone calls, referral handling, care coordination, and assisting with eligibility. Preferred qualifications include military healthcare service experience or knowledge of the TRICARE ACD program, and a Bachelor's degree in social work, psychology, or a related health discipline. Knowledge of Autism Spectrum Disorder, Applied Behavior Analysis, and related therapies is also preferred. A stable internet connection with at least 25 Mbps download and 10 Mbps upload speeds is necessary for remote work.

Responsibilities

The Care Management Support Assistant will assist TRICARE beneficiaries with Autism Spectrum Disorder (ASD) related services, ensuring eligibility for the Autism Care Demonstration (ACD). This role involves supporting the Autism Service Navigator by verifying eligibility, monitoring families for 180 days, and addressing barriers to accessing services. Responsibilities include educating families and registering them in the ECHO portal, assisting with regional transfers, processing faxes for ECHO eligibility and ACD requirements, and identifying ABA providers and necessary resources. The assistant will also manage communications, research provider availability and beneficiary preferences, identify local resources, resolve ECHO enrollment issues, and facilitate the transition from provisional to permanent ECHO status. Additionally, the role requires ensuring accurate documentation in all systems, communicating ECHO requirements to beneficiaries, and collaborating with other departments to support ACD goals and Humana's values.

Skills

Care Management

Eligibility Verification

Autism Care Demonstration (ACD)

ECHO registration portal

ABA provider identification

Electronic records system

Clinical management system

Care coordination

Provider interface

Communication

Problem-solving

Resource research

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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