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Humana

Sells Medicare health plans and runs senior clinics

Case Manager

Case Management & AdvocacyPosted on Nov 11
Full-timeWisconsin, USA

About the Job

Requirements

  • A bachelor's degree in human services or a related field and at least 1 year of experience serving frail elders or adults with intellectual, developmental, or physical disabilities, or a bachelor's degree in another field and at least 3 years of that experience.
  • A valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
  • A dedicated work space without ongoing interruptions to protect member protected health information and HIPAA information; home internet must provide at least 25 Mbps download and 10 Mbps upload.
  • Successful candidates must complete tuberculosis screening.

Responsibilities

  • Assess members' health and safety needs, strengths, interests, and preferences to develop a comprehensive Member Care Plan.
  • Coordinate with a Field Care Nurse to address members' health and safety needs and ensure support is provided in the least restrictive environment according to the Member Care Plan.
  • Conduct face-to-face social assessments upon member enrollment and at least every six months, typically at members' residences.
  • Conduct quarterly in-person visits and maintain monthly contact with members by phone.
  • Arrange support services for social integration, community resources, employment, housing, and other non-medical needs.
  • Ensure cost-effective service delivery.
  • Evaluate risk factors and provide education to members.
  • Maintain accurate case notes, service authorizations, and Member Care Plan updates.
  • Travel to member or assignment locations and, occasionally, to Humana offices for training or meetings.

Desired Qualifications

  • Reside within 45 minutes or less of the assigned coverage area.
  • Case management experience.
  • Experience with electronic case note documentation.
  • Knowledge of community health and social service agencies and additional community resources.

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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