Care Coordination, Initiation Team

About the role

Become a part of our caring community

Join Humana as a Care Coordinator and make a meaningful impact on the lives of Illinois Medicaid members. As part of the Initiation Team supporting Humana's Illinois HealthChoice Medicaid Managed Care program, you will serve as one of the first points of contact for newly enrolled members. You will proactively outreach to members, complete comprehensive Health Risk Assessments (HRAs), identify immediate healthcare and social service needs, and help connect members to appropriate services and resources.

Working closely with members during the early stages of their healthcare journey, you will help establish a strong foundation for ongoing care by coordinating initial support, addressing barriers to care, and facilitating access to needed programs and services.

If you are passionate about helping others navigate healthcare and community resources and ensuring a seamless transition into care management services, we encourage you to apply.

• Visit Medicaid enrollees in their homes, Assisted Living Facilities, and/or Long-Term Care Facilities and other care settings - 75% local travel.
• Ensure enrollees are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
• Identify and resolve barriers that hinder effective care.
• Plan and implement interventions to meet care needs.
• Coordinate services, monitors, and evaluates the case management plan against the enrollee's personal goals.
• Ensure the enrollee is progressing towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with members, and active care planning.
• Assess and evaluates enrollee's needs via telephonic and face to face assessments and evaluations, to coordinate services and address enrollee needs.
• Assist enrollee to remediate immediate and acute gaps in care and access.
• Assist enrollee with filing grievances and appeals.
• Provide information to enrollee related to MCO requirements, services, and benefits.
• Provide enrollee with information and/or referrals to community resources.
• Guide enrollees/families towards resources appropriate for their care. Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the enrollee's care as appropriate and required by our comprehensive contract.

Required Qualifications

The Care Coordinator must meet one (1) of the following requirements

• Bachelor's degree in social sciences, social work, human services, or a related field.
• Unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one (1) year experience conducting comprehensive assessments and provision of formal service for the elderly.
• Licensed Professional Counselor (LPC).
• Licensed Social Worker (LSW).

The Care Coordinator must meet all following requirements

• Must reside in the state of Illinois.
• 1+ years of experience in health care and/or case management.
• 1+ years of experience with Medicare & Medicaid recipients and/or long-term care and/or Home and Community based services and/or working with managed care organizations.
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
• Experience using a variety of electronic information applications/software programs including electronic medical records.

Additional Information

• Workstyle/Travel: This is a Field position that requires 75% travel in the field to visit members.
• Schedule: Monday - Friday 8am - 5pm CST but open to flexible work schedule. Possibility of working additional hours based on business needs.

Driving

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

TB

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours
• 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$53,700 - $72,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.