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

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Master’s degree in social work from an accredited university
Current, unincumbered, social work license; LMSW, LCSW, LICSW
Must have passed ASWB Exam (Master, Advance 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
Willingness to obtain/maintain social work licensure in multiple states, based on business need

Responsibilities

Assess and evaluate members' needs and requirements to achieve and/or maintain optimal wellness state
Guide members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
Use structured assessments along with critical thinking skills to determine appropriate interventions such as care coordination, health education, connection to community resources, full utilization of benefits and advocacy
Communicate effectively and professionally with providers, community resources, and other members of the interdisciplinary team to address member needs
Make outbound call attempts to members with social determinants of health (SDOH) needs to assess and assist with coordinating care with available plan benefits and/or appropriate community resources
Receive inbound calls from members needing additional assistance
Assess the member to determine if a referral to any other discipline is needed depending on member’s individualized needs
Creating and updating member care plans
Documentation in the member’s record to ensure CMS compliance, and accurately reflect work with members, providers, and other members of the interdisciplinary care team

Skills

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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