Care Coach - Stars Quality

Humana Inc; Santa Fe (NM); Remote; USD 54,000 - 73,000; Full time

Job summary

Humana Inc. is seeking a Care Coach to evaluate member needs, coordinate care, and drive interventions that improve health outcomes and member experience.

You will collaborate with members, caregivers, providers, and internal partners to close care gaps and promote adherence to treatment plans for Medicare Advantage populations. You will conduct proactive outreach, review assessments, and document outcomes in the systems, while complying with program, regulatory, and documentation requirements.

Qualifications

• Associate degree in any field.
• At least two (2) years of direct adult patient care experience.
• Experience collaborating with members of a healthcare team.
• Strong computer proficiency and ability to learn multiple software applications, including EMR.

Responsibilities

• Engage members via telephonic outreach to support care plans.
• Review data and complete assessments to identify clinical, financial, functional, and social needs.
• Educate members about preventive care and connect to healthcare and social resources.
• Collaborate with care managers, providers, and multidisciplinary teams to resolve barriers to care.

Skills

Healthcare communication

Team collaboration

MS Office

EMR systems

Education

Associate degree in any field

Tools

EMR software

Microsoft Office

Job description

Become a part of our caring community

The Care Coach evaluates member needs, coordinates care, and drives interventions that support improved health outcomes, member experience, and quality performance. You will collaborate closely with members, caregivers, providers, community organizations, and internal partners to identify and resolve barriers to care, close care gaps, and promote adherence to treatment plans across Humana's Medicare Advantage populations.

Schedule and Training

• Work Style: Work at Home
• Training: Mandatory for the first four weeks, 8:30 a.m.–5:00 p.m. ET.
• Work Schedule: Monday - Friday, 10:00 a.m. - 8:00 p.m. ET after training.
• Time off is not permitted during the first month of training. The first 90 days following training are critical to building a strong foundation; therefore, planned or unplanned time away should be minimized.

What Success Looks Like

• You will engage members in Stars and quality initiatives, including Depression Screening and Follow-Up (DSF) and Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC), and other evolving member outreach that improve member outcomes, experience, and organizational performance.
• You will demonstrate agility and adaptability by supporting multiple Stars programs, including DSF, FMC, and other quality improvement initiatives as member health needs evolve.
• You will conduct proactive telephonic outreach to members, primarily through an autodialer and other approved communication channels.
• You will review available data and complete structured assessments to identify clinical, financial, functional, and social needs.
• You will educate members about preventive care and connect them with appropriate healthcare, community, and social support resources.
• You will collaborate with care managers, providers, and multidisciplinary partners to resolve barriers, promote member independence, and support desired health outcomes.
• You will document assessments, outreach, and outcomes accurately and timely in applicable systems.
• You will follow all program, regulatory, compliance, and documentation requirements.
• You will navigate multiple computer systems while providing member-focused support in a fast-paced, structured environment.
• You will adapt communication and workflow priorities to support diverse populations, evolving campaigns, and changing business needs.

Use your skills to make an impact

Required Qualifications

• Associate degree in any field.
• At least two (2) years of direct adult patient care experience, such as long-term care, home- and community-based services, a hospital or facility setting, case management, or a managed care organization.
• Experience collaborating with members of a healthcare team.
• Strong computer proficiency and demonstrated ability to learn and navigate multiple software applications, including electronic medical records.

Preferred Qualifications

• Experience in a telephonic environment working with geriatric, vulnerable, and/or low-income populations.
• Experience supporting Medicare, Medicaid, Dual Eligible Special Needs Plans (D-SNP), Chronic Special Needs Plans (C-SNP), or other managed care populations.
• Experience supporting quality improvement or Stars-related initiatives.
• Experience conducting member outreach and engagement activities, up to and including screening for depression symptoms and other barriers of care.
• Knowledge of community resources and social determinants of health.
• Experience working in a remote environment.
• Experience motivating others to improve their health.

Additional Information

• Applicants who currently hold an RN, LPN, LVN, APRN, NP, LMSW, or LCSW license are not eligible for consideration for this position.
• Strong communication and interpersonal skills, with the ability to build rapport with members, providers, internal teams, and other stakeholders.
• Strong organizational skills and attention to detail.
• Intermediate proficiency with Microsoft Office applications and healthcare documentation systems.
• Ability to work independently, manage competing priorities, and adapt quickly in a fast-paced environment.

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.

Florida Background Screening Requirements:

Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.

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. 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many 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 atHumana.comand atCenterWell.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, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.