FCP Case Manager

Humana•Racine, WI

5d•Remote

About The Position

Humana/iCare is seeking a Case Manager/Care Coach to join the growing GSR3 team in the Family Care Partnership (FCP) program, serving Milwaukee, Racine, Kenosha, Walworth, Waukesha, Washington, Ozaukee, and Sheboygan counties. The position provides care management services to adults with disabilities and frail elders, including assessment, service-plan development, ongoing care coordination, quality assurance, and monitoring of services. This is a field role requiring travel to members’ residences and other locations in the service area. The role is scheduled Monday through Friday, 8:30 a.m. to 5:00 p.m. Central Time, with 40 scheduled hours per week and travel of up to 75% of the time. The role is remote, with occasional travel to Humana offices for training or meetings. Mileage reimbursement is provided for eligible work-related travel. A valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits are required. The position is patient-facing and requires TB screening. Home-based work requires an internet connection with at least 25 Mbps download and 10 Mbps upload, and a dedicated space that protects member PHI/HIPAA information. The posted annual base-pay range is $53,700–$72,600. Humana offers medical, dental, and vision benefits; a 401(k) retirement savings plan; paid time off and company and personal holidays; paid parental and caregiver leave; short- and long-term disability; life insurance; and other benefits.

Requirements

Meet one of the following qualification pathways: Wisconsin-certified Social Worker with at least one year of experience working with at least one Family Care target population; a four-year bachelor’s degree or advanced degree in a human services area and at least one year of such experience; or a four-year bachelor’s degree or advanced degree in another area and at least three years of such experience.
Experience must involve at least one Family Care target population: frail elders, people with physical disabilities, or people with intellectual/developmental disabilities.
Knowledge of community resources available to meet members’ needs and a thorough understanding of community long-term care options.
Ability to travel throughout Milwaukee, Walworth, Racine/Kenosha, Waukesha, Washington, Ozaukee, and Sheboygan counties to conduct assessments in members’ residences.
Valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
For home-based work, internet service must provide at least 25 Mbps download and 10 Mbps upload, and work must be performed from a dedicated space that protects member PHI/HIPAA information.
Must complete TB screening if selected for the role.

Nice To Haves

Certification or licensure in Social Work in Wisconsin, or eligibility for certification and licensure.
Previous managed care experience.
General knowledge of Medicaid and Medicare benefits.

Responsibilities

Conduct psychosocial assessments as part of the comprehensive assessment process.
Use the Resource Allocation Decision-making methodology (RAD) to help members identify preferred outcomes and strategies, including community resources and cost-effective services or equipment.
Coordinate and monitor services and resources intended to meet members’ outcomes and track progress toward those outcomes.
Conduct periodic reassessments, update member care plans, and monitor health and safety.
Assist members or their representatives with complaints, grievances, and obtaining advocacy services.
Document member information and contacts regarding care and services, following applicable policies, procedures, workflows, audit requirements, and time frames.
Build constructive working relationships with members, their families, and appropriate outside agency staff.
Facilitate collaboration with physicians or appropriate medical professionals to coordinate member care.
Assist with resolving problems between members and providers.
Educate members and providers about benefits, service providers, protocols for accessing resources, and appropriate use of medical services.
Provide referrals to community resources and social services as needed.
Monitor members’ ability and willingness to engage in treatment regimes and work with staff, members, and providers to identify alternatives or solutions.