Care Coach

Humana Inc; Illinois; Hybrid; USD 54,000 - 73,000; Full time

Job summary

Humana Inc. is seeking a Care Coach for the IL HealthChoice Medicaid team. The role involves building connections with members, assessing needs, coordinating services, and guiding members through their healthcare journey from a whole-person perspective.

Responsibilities include outreach, risk stratification, referrals to care management, and ensuring compliance with regulatory standards. The position requires residence in Illinois or nearby border state, 1+ year in healthcare/case management,

Qualifications

• Bachelor's degree in social sciences, social work, human services, or related field.
• Unrestricted LPN in Illinois.
• Licensed Professional Counselor (LPC) or Licensed Social Worker (LSW).

Responsibilities

• Perform member outreach to screen members for risk stratification and ensure compliance with outreach and contact requirements.
• Identify triggers for referral into care management, chronic condition disease management, and other care management and/or specialty programs.
• Screen members using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
• Employ various strategies to manage a member’s health issues including identifying and resolving barriers to care.
• Promote communication with providers and health care team members to enhance care management services.
• Ensure members progress towards outcomes by monitoring care through assessments, data, and conversations.
• Participate in a multi-disciplinary team.
• Adhere to compliance with policies and regulatory standards.
• Maintain documentation meeting risk management, regulatory, and accreditation requirements.
• Protect confidentiality of member information per HIPAA and company policies.
• Meet daily metrics with speed and accuracy.
• Complete documentation of member calls in the electronic record with required actions.

Education

Bachelor's degree in social sciences, social work, human services, or a related field

Unrestricted Licensed Practical Nurse (LPN) in the state of Illinois

Licensed Professional Counselor (LPC)

Licensed Social Worker (LSW)

Job description

Become a part of our caring community Are you passionate about improving access to care and helping people live healthier lives? Join Humana's IL HealthChoice Medicaid team as a Care Coach, where you'll build meaningful connections with members and guide them through their healthcare journey. Using a whole-person approach, you'll assess needs, coordinate services, and connect members with valuable resources that support their health, independence, and overall well-being.

Position responsibilities

• Perform member outreach to screen members for risk stratification and ensure compliance with outreach and contact requirements.
• Identify triggers for referral into care management, chronic condition disease management, and other care management and/or specialty programs.
• Screen members using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
• Employ a variety of strategies, approaches and techniques to manage a member’s health issues including identifying and resolving barriers that hinder effective care.
• Promote communication, both internally and externally, to enhance effectiveness of care management services (e.g. providers, and health care team members respectively).
• Ensure members progress towards desired outcomes by continuously monitoring member care through use of assessment, data, and conversations with members, and active care planning.
• Participate in a multi-disciplinary team including internal and external participants.
• Adhere to compliance with policies and procedure/regulatory standards.
• Maintain accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protect the confidentiality of member information and adheres to company policies regarding confidentiality.
• Demonstrate ability to meet daily metrics with speed, accuracy, and a positive attitude.
• Complete documentation of member calls in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.

Required Qualifications

The Care Coordinator must meet one (1) of the following requirements:

• Bachelor's degree in social sciences, social work, human services, or a related field.
• Unrestricted Licensed Practical Nurse (LPN) in the state of Illinois.
• Licensed Professional Counselor (LPC) Licensed Social Worker (LSW).

The Care Coordinator must meet all following requirements:

• Must reside in Illinois or a border state within a commutable distance of IL.
• 1+ years of experience in health care and/or case management.
• 1+ years of experience with Medicare & Medicaid recipients and/or working with managed care organizations.

Preferred Qualifications

• Bilingual English - Spanish/Polish/Arabic/Creole
• Certified Case Manager (CCM)
• Master's degree in health service-related field
• Prior experience with Medicare & Medicaid recipients
• Previous experience with electronic case notes documentation and experienced with documenting in multiple computer applications/systems
• Experience with health promotion, coaching and wellness
• Knowledge of community health and social service agencies and additional community resources
• Experience with case management, discharge planning and patient education for adult acute care
• Familiarity with basic medical terminology and concepts used in care management preferred.

Additional Information

• Workstyle: This is a remote position that requires travel.
• Travel: Up to 25% field-based interactions meeting with members and/or their families, community partners and other care teams. May need to attend occasional onsite meetings in Humana's Illinois locations.
• Typical Workdays and Hours: Operating hours are Monday - Friday 8:00 AM - 7:00 PM CST but core hours for this position are primarily Monday - Friday, 8:00 AM - 5:00 PM CST. May need to be flexible with work schedule based on business needs.
• Driving: This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
• TB: This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours 40 Pay 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. $53,700 - $72,600 per year

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.

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurancemany other opportunities

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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.