Humana

Field Care Manager, ARTS -- Northern Virginia

Virginia, United States

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

Position Overview

  • Location Type: Remote (with travel)
  • Job Type: Full-time
  • Salary: Not specified
  • Region: NOVA (Northern Virginia)

This role involves assessing and evaluating member needs to promote optimal wellness. The Field Care Manager, Behavioral Health 2 will guide members and families toward appropriate resources for care and well-being, interpreting situations and determining courses of action independently.

Responsibilities

  • Utilize high-quality, evidence-based substance use services through personalized care coordination, crisis intervention, peer support, and collaboration with medical, behavioral health, and ARTS providers.
  • Provide comprehensive, integrated support to members experiencing substance use and possible co-occurring conditions, including children, adolescents, adults, and justice-involved members.
  • Engage members in their communities, meeting them face-to-face whenever possible to build trust and facilitate meaningful care coordination.
  • Complete all required assessments, including the Comprehensive Risk Assessment (CHRA).
  • Coordinate behavioral health, substance use, and medical services, ensuring appropriate provider engagement and adherence to treatment plans.
  • Improve member’s health literacy while addressing health-related social needs to positively impact member’s healthcare outcomes and well-being.
  • Serve as the lead of the member’s interdisciplinary care team (ICT), overseeing care planning, transitions, and service delivery.
  • Facilitate ICT meetings, ensuring seamless communication among providers, Service Coordinators, and Care Management Extenders.
  • Engage in biannual and quarterly face-to-face visits, ensuring continuous monitoring and proactive intervention.
  • Work with autonomy but reach out when support is needed.
  • Collaborate with internal departments, providers, and community-based organizations to link to appropriate services and create a seamless, culturally competent care experience that respects the members’ preferences and needs.
  • Follow processes and procedures to ensure compliance with regulatory requirements by the Virginia Department of Medical Assistance Services (DMAS) and Center for Medicare and Medicaid.

Requirements

  • Must reside in Virginia.
  • Active LMHP License in the state of Virginia.
  • Minimum of 1 year of experience working directly with individuals with substance use disorder (SUD).
  • Case management experience providing care transitions for ASAM levels of care and overall structured care management for members receiving VA Addiction and recovery services.
  • Ability to travel to region-based facilities and homes for face-to-face assessments (up to 25% of the time).
  • Exceptional oral and written communication and interpersonal skills with the ability to quickly build rapport.
  • Ability to work with minimal supervision within the role and scope.
  • Ability to use a variety of electronic information applications/software programs, including electronic medical records.
  • Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel.
  • Valid driver's license, car insurance, and reliable transportation.

Preferred Qualifications

  • Case Management Certification (CCM).
  • Experience working with Medicare, Medicaid, and dual-eligible populations.
  • Field Case Management Experience.
  • Experience working with pregnant and post-partum population with SUD, including Substance Exposed Infants.
  • Knowledge of community health and social service agencies and additional community resources.
  • Knowledge of ASAM levels of care.
  • Managed Care Experience.
  • Bilingual preferred (Spanish, Arabic, Vietnamese or other).

Skills

Care Coordination
Crisis Intervention
Peer Support
Behavioral Health
Substance Use Services
Assessment
Care Planning
Interdisciplinary Team Management
Health Literacy
Social Needs Addressing

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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