[Remote] Care Manager, Telephonic Behavioral Health at Humana

Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Military HealthIndustries

Requirements

Conduct assessments for development of comprehensive care plans (CCP) and update CCP at least every 6 months
Notify and provide copies of CCP to providers and parents/caregivers
Ensure all baseline measures are completed as required by ACD policy
Collect outcome measures as defined by ACD policy and provide data to providers
Serve as point of contact (POC) for MTF CMs
Perform telephonic care management with beneficiaries in the East region, focusing on ASD treatment coordination
Assess beneficiary and family needs, collaborating with providers, caregivers, and others to initiate treatment and address barriers
Determine necessary resources for families, including educational programs, community resources, materials, and support groups
Utilize Motivational Interviewing and solution-oriented approaches in communication
Work collaboratively with enterprise stakeholders for consultative assistance, service coordination, and integrated care plan meetings
Provide professional and courteous service to callers, resolving complaints or issues
Participate in and facilitate Coordinated Team Conferences, including medical team conferences for ASD beneficiaries
Ensure provider compliance with attendance and policies for conferences; create and share documented meeting minutes
Actively communicate with other ASNs for continuity of care during beneficiary relocations
Assist families in identifying local or other resources, including Respite care for ADFMs
Monitor ECHO registration and EFMP enrollment, ensuring required documentation and completion of application processes
Follow beneficiaries to ensure coordination and approval of services

Responsibilities

Serve as primary advocate for assigned beneficiaries and families under the Autism Care Demonstration (ACD)
Collaborate and oversee assessment, planning, facilitation, care coordination, evaluation, and advocacy for comprehensive health needs
Coordinate medical, behavioral, and other services for beneficiaries with primary ASD diagnosis
Act as Humana Military liaison to TRICARE beneficiaries, providers, and others involved in care planning
Collaborate with other CMs to coordinate care activities
Participate in care management and coordination in accordance with Medical Management policies and procedures
Develop comprehensive care plans in collaboration with stakeholders when appropriate
Participate in Coordinated Team Conferences for complex beneficiaries with ASD and co-occurring conditions
Ensure goals in team conferences are appropriate and not in conflict with other treatment plans

Skills

Care Management

Care Coordination

Autism Spectrum Disorder

Telephonic Care

Care Planning

Assessment

Advocacy

TRICARE

Behavioral Health

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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