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Humana

Sells Medicare health plans and runs senior clinics

Care Coordinator

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeIllinois, USA$53.7k - $72.6k /yr

About the Job

Requirements

  • Meet one of the following qualifications: a bachelor's degree in social sciences, social work, human services, or a related field; an unrestricted Illinois Licensed Practical Nurse license with one year of experience conducting comprehensive assessments and providing formal services for the elderly; a Licensed Professional Counselor license; or a Licensed Social Worker license.
  • Reside in Illinois.
  • Have at least one year of experience in health care and/or case management.
  • Have at least one year of experience with Medicare and Medicaid recipients, long-term care, Home and Community-Based Services, or managed care organizations.
  • Have intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
  • Have experience using electronic information applications and software programs, including electronic medical records.
  • Have a valid state driver's license and maintain personal vehicle liability insurance at the applicable state minimum limits or the specified higher limits.
  • Complete tuberculosis screening if selected.
  • Meet the home-work internet requirements of at least 25 Mbps download and 10 Mbps upload, and work from a dedicated space without ongoing interruptions to protect member protected health information.

Responsibilities

  • Visit Medicaid members in their homes, assisted living facilities, long-term care facilities, and other care settings; the role requires 75–90% local field travel.
  • Assess members' care needs to ensure they receive services in the least restrictive setting that supports or maintains their well-being.
  • Identify and resolve barriers that hinder effective care.
  • Plan and implement interventions to meet care needs.
  • Coordinate services, monitor the case management plan, and evaluate it against members' personal goals.
  • Continuously monitor patient care using assessments, data, conversations with members, and active care planning to evaluate progress toward desired outcomes.
  • Assess and evaluate enrollees' needs through telephone and face-to-face assessments and evaluations to coordinate services and address their needs.
  • Help enrollees remediate immediate and acute gaps in care and access.
  • Assist enrollees with filing grievances and appeals.
  • Provide enrollees with information about managed care organization requirements, services, and benefits.
  • Provide enrollees with information and referrals to community resources.
  • Guide members and families toward appropriate care resources by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member's care, as appropriate and required by the contract.

About the Company

Humana

Sells Medicare health plans and runs senior clinics

Humana sells health insurance paid for by government programs, chiefly Medicare Advantage plans that private insurers run for Americans 65 and older in place of traditional Medicare. It ranks among the largest Medicare Advantage insurers in the country and also runs Medicaid plans for low-income families in several states. Its CenterWell business operates senior primary care clinics, a mail-order pharmacy and home health services, so many members get care from a company the insurer owns. Medicare and states pay Humana a set monthly amount per member, and it keeps the difference between those payments and members' medical costs. Humana was founded in 1961 as a nursing home company and is based in Louisville, Kentucky.

Company size
10,001+
Company stage
IPO
Headquarters
Louisville, KY
Founded
1961

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