Care Coordinator

CenterWell Certified Healthcare Corp.; Springfield (IL); On-site; USD 52,000 - 76,000; Full time

Job summary

Humana seeks a Care Coordinator to support Illinois Medicaid members in preventing gaps in care by assessing needs, creating personalized plans, and coordinating community resources. The role emphasizes in-home and facility visits, standard telephonic assessments, and active care planning to drive optimal health outcomes.

The position requires IL residency, 1+ year healthcare experience, and qualifications from a degree or professional license as listed.

Qualifications

• The candidate must reside in Illinois and have 1+ year of healthcare or case management experience.
• Must meet one of the listed qualifications (degree or license).
• Experience with Medicare/Medicaid and/or long-term care is preferred.

Responsibilities

• Visit Medicaid members in homes, assisted living facilities, or long-term care settings.
• Assess care needs and develop personalized care plans to achieve optimal well-being.
• Coordinate services, monitor progress, and adjust plans to meet goals.
• Assist with filing grievances and appeals and provide information on benefits.
• Connect members with community resources and other payer supports.

Skills

Care coordination

Home visits

Assessment

Telephonic assessments

Education

Bachelor's degree in social sciences / social work / human services

Unrestricted LPN license (Illinois)

Licensed Professional Counselor (LPC)

Licensed Social Worker (LSW)

Job description

Become a part of our caring community

Join Humana Gold Plus Integrated as a Care Coordinator and make a meaningful impact on the lives of Illinois Medicaid Members. As a Care Coordinator supporting Humana's Illinois HealthChoice Medicaid Managed Care program, you will play a vital role in helping members achieve their best possible health and well-being. Reporting to the Manager, Care Management, you will assess member's unique needs, develop personalized care plans, and connect individuals and families with the resources and support they need to thrive.

Upon hire, you will be assigned to support either MLTSS or LTSS based on business needs.

This position will support members within the catchment 13 area which includes the following IL counties: Mason, Logan, Menard, Cass, Scott, Morgan, Sangamon, and Christian.

The Care Coordinator responsibilities are as follows:

• Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long-Term Care Facilities and other care settings - 75%-90% local travel.
• Ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
• Identify and resolve barriers that hinder effective care.
• Plan and implement interventions to meet care needs.
• Coordinate services, monitor, and evaluate the case management plan against the member's personal goals.
• Ensure the patient is progressing towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with members, and active care planning.
• Assess and evaluate enrollee's needs via telephonic and face to face assessments and evaluations, to coordinate services and address enrollee needs.
• Assist enrollee to remediate immediate and acute gaps in care and access.
• Assist enrollee with filing grievances and appeals.
• Provide information to enrollee related to MCO requirements, services, and benefits.
• Provide enrollee with information and/or referrals to community resources.
• Guide members/families towards resources appropriate for their care. Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member's care as appropriate and required by our comprehensive contract.

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 with one (1) year experience conducting comprehensive assessments and provision of formal service for the elderly.
• Licensed Professional Counselor (LPC).
• Licensed Social Worker (LSW).

The Care Coordinator must meet all following requirements:

• Must reside in the state of Illinois.
• 1+ years of experience in health care and/or case management.
• 1+ years of experience with Medicare & Medicaid recipients and/or long-term care and/or Home and Community based services and/or working with managed care organizations.