[Remote] Care Management Support Assistant at Humana

Florida, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

U.S. Citizenship
Interim approval for government security clearance (NBIS)
Ability to work a shift of 10:30 a.m. - 7 p.m. E.T
Medical terminology experience and/or UM/Coding Experience
3 years experience in customer service or referral management
3 years of experience in healthcare/medical or health information management

Responsibilities

Process referrals from Military Treatment Facilities (MTFs) and civilian providers for the Autism Care Demonstration (ACD) program
Process referrals into the medical management system with emphasis on accuracy and timeliness
Monitor phone queues and secure messaging to answer provider/beneficiary inquiries
Perform data entry into the medical management system
Review eligibility for ECHO benefits
Review assessments and documentation to pend tasks
Provide non-clinical support to the assessment by answering questions, evaluating beneficiaries needs, identifying problems and possible solutions, and routing calls appropriately
Recognize ACD specific assessments/treatment plans and pend referrals and authorizations to appropriate point of contact
Understand TRICARE ACD benefits/limitations per the TRICARE Operations Manual (TOM)
Coordinate authorizations with Autism Services Navigators and Utilization Management
Answer questions from associates and MTF/ civilian providers to obtain additional information
Monitor timeliness in the medical management authorization system to ensure referrals are pended within 24 hours
Answer inbound calls on the TRICARE Autism Care Demonstration utilizing available resources
Identify call and call inquiry
Document calls through the customer service documentation system
Educate beneficiaries and providers regarding the TRICARE ACD program
Demonstrate complex problem solving ability utilizing analytical skills, and deductive reasoning skills
Consistently recognize, promote, and deliver quality customer service

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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