Care Management Support Assistant

Humana Inc; Town of Florida, Northern (NY, KY); Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off

Remote work option

Job summary

Humana Inc. is seeking a Care Management Support Assistant to help administer care management, guiding members and families toward appropriate resources. The role performs non-clinical tasks, reviews referrals, verifies benefits, and coordinates with providers while ensuring HIPAA compliance.

The position is remote (Florida) with full-time hours and potential travel to Humana offices for training or meetings. A strong customer-service background is essential.

Qualifications

• 1-3 years of Home Health or Infusion Pharmacy experience.
• Wound care/Ostomy supplies experience preferred.
• Microsoft Office (Word/Outlook/Excel) experience preferred.
• Knowledge of Medicare/Medicaid & commercial insurance required.
• Experience with medical authorizations required.
• Knowledge of medical billing preferred.

Responsibilities

• Review inbound referrals and correspondence for processing and resolution.
• Verify benefits coverage and eligibility per Health Plan contract.
• Process or route referrals, and educate members/providers on status.
• Coordinate care delivery with providers and internal teams.
• Maintain HIPAA compliance and protect patient information.

Skills

Customer service

Communication skills

Medicare/Medicaid knowledge

Medical authorizations

Medical billing knowledge

Tools

Microsoft Office

Job description

## Care Management Support AssistantApply: Remote Florida: Full time: Posted Today: R-431125# **Become a part of our caring community**The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' 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 Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care regarding referred services. Maintain working knowledge of applicable CPT, HCPC, ICD-10 codes, and all insurance contracts. Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines. Maintain knowledgeable of, and adhere to applicable federal/state regulations, laws related to patient confidentiality, release of information, and HIPAA. Always preserve the security and confidentiality of patients’ personal information. Report ongoing issues with referring entities or providers that delay service delivery to manager. Provides excellent internal and external customer service by ensuring work meets quality standard.# **Use your skills to make an impact****Required Qualifications*** 1-3 years of Home Health, or Infusion Pharmacy experience is required.* Wound care/Ostomy supplies experience is preferred.* Microsoft Office technical experience with Word, Outlook, and Excel is preferred.* Knowledge of Medicare/Medicaid & commercial insurance is required.* Experienced with medical authorizations is required.* Knowledge of medical billing is preferred.* Must be passionate about contributing to an organization focused on continuously improving consumer experiences* Excellent customer service and communication skills.**Additional Information*** Remote (Subject to potential future adjustments based on evolving business requirements)* Overtime: As neededWork 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.$38,000 - $45,800 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 OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.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.