FCP Case Manager

Humana•Waukesha, WI

6d•$53,700 - $72,600•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-based, remote position involving travel to member residences and other locations to conduct assessments. Travel may reach 75% of the time, and occasional travel to Humana offices for training or meetings may be required. Typical hours are Monday through Friday, 8:30 a.m. to 5:00 p.m. Central Time, with 40 scheduled hours per week. The role requires a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. Mileage reimbursement is provided for qualifying work-related travel. The position is patient-facing and requires TB screening if selected.

Requirements

Meet one of the following qualification paths: Wisconsin-certified social worker with at least one year of experience working with at least one Family Care target group; a four-year bachelor's degree or higher in a human services area with at least one year of relevant experience; or a four-year bachelor's degree or higher in another area with at least three years of relevant experience.
Relevant experience must involve at least one Family Care target population: frail elders, physically disabled people, or people with intellectual/developmental disabilities.
Knowledge of community resources available to meet members’ needs and a thorough understanding of long-term care options available in the community.
Ability to travel within 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.
Meet the work-at-home internet requirements if working from home: minimum download speed of 25 Mbps and upload speed of 10 Mbps, with a dedicated space that protects member PHI/HIPAA information.

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 used to meet members’ identified outcomes, and track progress toward those outcomes.
Conduct periodic reassessments, update members’ care plans, and monitor health and safety.
Assist members or their representatives with complaints, grievances, and obtaining advocacy services.
Document member information and contacts related to care and services.
Create documentation in accordance with policies, procedures, workflows, audit requirements, and time frames.
Build constructive working relationships with members, family members, and appropriate outside agency staff.
Collaborate with members’ physicians or appropriate medical professionals to coordinate care.
Help resolve problems between members and providers.
Educate members and providers about benefits, service providers, protocols for accessing resources, and appropriate use of medical services.
Refer members 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.