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Humana Health Horizons in Ohio is seeking Field Care Managers, Behavioral Health 2 who will assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.The BH CM must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are notassigned to a Care Coordination Entity, the OhioRISE Plan, and/or a Care Management Entity, or who choose to receive their care management from the MCO. The BH CM would serve as the single point of contact for care coordination.
Or
The BH CM Plus must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity, the OhioRISE Plan, CPCs, and/or a Care Management Entity. Care Manager Plus serves as the single point of contact for care coordination.
- Ensuring the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
- Providing actionable data, information, and support to assist the CCE, OhioRISE Plan, and/or CME in meeting the member's care needs.
- Integrating information collected by the external Care Coordination Entities into the Care Coordination Portal to minimize duplication of efforts.
Position Responsibilities:
The Field Care Manager, Behavioral Health 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care.
- Performs telephonic and face to face assessments and evaluations of the member’s needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
- Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
- Creates member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Collaborates with providers and community services to promote quality and cost-effective outcomes.
- Ensures the delivery of needed services/supports for Behavioral Health, Physical Health, Social Determinant of Health and value added benefits.
- Coordinates across the transdisciplinary care team and with the PCP and supports transitions of care.
- Submits incident reports.
Use your skills to make an impact
Required Qualifications
- Must reside in Ohio in Cuyahoga County.
- Applicable state licensure in field of study with no disciplinary action: Licensed Masters Clinical Social Worker (LCSW), Clinical Social Worker (CSW), Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), or Registered Nurse (RN).
- Minimum of 2 years of post-degree clinical experience in a behavioral health setting.
- Case management experience.
- Must have a Child and Adolescent Needs & Strengths (CANS) certification or able to obtain one within 60 days of hire.
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Preferred Qualifications:
- Case Management Certification (CCM).
- Experience working with Medicare, Medicaid and dual-eligible populations.
- Field Case Management Experience.
- Health Plan experience.
- Knowledge of community health and social service agencies and additional community resources.
- Experience with health promotion, coaching and wellness.
- Bilingual (Spanish, Somali or other).
Additional Information
- Workstyle: Combination remote work at home and onsite member facing.
- Hours: 40 hour work week Monday through Friday 8:00 AM 5:00 PM Eastern, over-time may be requested as business needs.
- Travel: Must be willing to commute about 50% to meet with members. More information will be provided during the interview.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$59,300 - $80,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
