Telephonic Case Manager

Humana•Work at Home - Wisconsin, WI

1d•$53,700 - $72,600•Remote

About The Position

Humana is hiring a Telephonic Case Manager to work from home and support members’ care journeys through phone-based case management. The role conducts assessments of members’ medical, behavioral, and social needs; develops and maintains individualized care plans; and coordinates care with members, providers, and community supports. The Case Manager also educates members about benefits, services, preventive health, and appropriate use of medical services, advocates for members, and documents care and service contacts. The position reports to the Manager of Care Management Support. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Central Time, with 40 scheduled hours per week. Although remote, occasional travel to Humana offices for training or meetings may be required. Employees must have a dedicated work area that protects member PHI/HIPAA information and home internet service meeting the stated minimum speeds of 25 Mbps download and 10 Mbps upload.

Requirements

Bachelor’s degree in a health and human services field.
At least 2 years of case management experience.
Must reside within the State of Wisconsin.

Nice To Haves

Bilingual ability.
Prior experience with Medicare and Medicaid recipients.
Prior behavioral health experience.
Previous experience with electronic case note documentation.
Knowledge of community health and social service agencies and additional community resources.

Responsibilities

Conduct initial and annual assessments of members’ medical, behavioral, and social needs.
Coordinate and organize assessment information to develop care plans that address members’ needs and ensure interventions are implemented collaboratively with members and their providers or supports.
Build working relationships with physicians, social service providers, and others by involving them in care coordination.
Assist with problem resolution involving members and providers, advocate for members, and provide information about the member grievance process.
Review, monitor, and update care plans as indicated.
Provide members and providers with information about benefits, service providers, and access protocols; educate members on appropriate use of medical services.
Refer members to community resources and social services.
Document member information and contacts related to members’ care and services provided.
Monitor members’ willingness to participate in treatment regimens and problem-solve with staff, members, and providers to identify alternatives or solutions to their needs.
Conduct follow-up calls after hospitalizations and emergency room visits according to policy.
Contribute to interdisciplinary iCare team meetings as a participant or facilitator.
Educate members about preventive health guidelines and programs.