[Remote] Special Needs Plan- Support Social Services at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Master’s degree in social work from an accredited university
Current, unencumbered social work license (LMSW, LCSW, LICSW)
Must have passed ASWB Exam (Master, Advanced Generalist, or Clinical level)
Minimum 3 years of experience working as a social worker in a medical healthcare setting
Proficient in Microsoft applications including Word, Outlook, Excel
Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously
Must be willing to obtain/maintain social work licensure in multiple states, based on business need
Work-at-home setup with minimum internet speed: 25 Mbps download, 10 Mbps upload (wireless, wired cable or DSL suggested; satellite, cellular, microwave only if approved)

Responsibilities

Assess and evaluate members' needs telephonically to achieve/maintain optimal wellness by guiding members/families to appropriate resources
Function as a Support Social Services associate in the Special Needs Plan (SNP) program as part of an interdisciplinary care team
Use structured assessments and critical thinking to determine interventions like care coordination, health education, community resource connections, benefit utilization, and advocacy
Communicate effectively and professionally with providers, community resources, and interdisciplinary team members (nurse care managers, dieticians, behavioral health, pharmacists)
Make outbound calls to members with social determinants of health (SDOH) needs to assess and coordinate care using plan benefits/community resources
Handle inbound calls from members needing assistance and conduct follow-up to ensure needs are addressed
Assess members to determine if referral to other disciplines is needed based on individualized needs
Create and update member care plans as required
Document in member records to ensure CMS compliance and accurately reflect work with members, providers, and team

Skills

Key technologies and capabilities for this role

Social WorkCare ManagementBehavioral HealthCare CoordinationHealth EducationSDOH AssessmentTelephonic CommunicationCommunity ResourcesInterdisciplinary TeamworkCritical Thinking

Questions & Answers

Common questions about this position

What qualifications are required for this role?

Candidates must have a Master’s degree in social work from an accredited university, a current unencumbered social work license (LMSW, LCSW, LICSW), passed the ASWB Exam at Master, Advanced Generalist, or Clinical level, and at least 3 years of experience as a social worker in a medical healthcare setting.

Is this position remote or work from home?

Yes, this is a telephonic, call center, work from home environment.

What is the salary for this position?

This information is not specified in the job description.

What does the team structure look like for this role?

The role functions as part of an interdisciplinary care team working with nurse care managers, dieticians, behavioral health professionals, and pharmacists to promote member health and well-being.

What makes a strong candidate for this position?

Strong candidates will have proficiency in Microsoft applications like Word, Outlook, and Excel, the capacity to manage multiple priorities and computer applications simultaneously, and willingness to obtain/maintain social work licensure in multiple states as needed.

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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