Care Manager, Telephonic Behavioral Health

Humana; Connecticut; Remote; USD 59,000 - 81,000; Full time

Job summary

Join a forward-thinking organization dedicated to transforming healthcare for individuals with autism. As a Telephonic Care Manager, you will play a crucial role in advocating for beneficiaries, coordinating care, and developing tailored care plans. This position requires a valid clinical license and a passion for helping others navigate their healthcare journey. You will engage with families and providers to ensure comprehensive support and address barriers to care. With a focus on quality outcomes, this role offers the opportunity to make a significant impact in the lives of those you serve while enjoying a supportive work environment that values your contributions.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Paid parental and caregiver leave

Volunteer time off

Qualifications

• Must have a relevant license (LCSW, LPC, RN) with clinical experience in pediatrics or behavioral health.
• Proficiency in Microsoft Office and strong communication skills are essential.

Responsibilities

• Serve as primary advocate for beneficiaries, coordinating care activities and developing comprehensive care plans.
• Perform telephonic care management and assess needs of beneficiaries and families.

Skills

Clinical experience in pediatrics

Behavioral health expertise

Care management experience

Proficiency in Microsoft Office

Skilled in written and verbal communications

Motivational Interviewing

Ability to handle high volume of calls

Analytical skills

Education

Licensed Clinical Social Worker (LCSW)

Licensed Professional Counselor (LPC)

Registered Nurse (R.N.)

Tools

Microsoft Office

Job description

Become a part of our caring community and help us put health first

The Telephonic Care Manager (Autism Care Navigator) serves as a primary advocate for assigned beneficiaries receiving care under the Autism Care Demonstration (ACD). The ASN (Autism Care Navigator) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

Job Description

The Telephonic Care Manager (Autism Care Navigator) serves as a Humana Military liaison to TRICARE beneficiaries, providers and others involved in the care planning for beneficiaries receiving services under the TRICARE program.

Role Responsibilities

• Serves as primary advocate for beneficiary & family collaborating with other CMs to coordinate care activities; conduct assessment for development of comprehensive care plan (CCP); update CCP at least every 6 months; notify & provide copy of CCP to providers & parents/caregivers; ensure all baseline measures are completed as required by ACD policy; collect outcome measures as defined by ACD policy, provide outcome measure data to respective providers; serve as POC for MTF CMs.

• Perform telephonic care management with beneficiaries throughout the East region with a focus of coordination of services for any treatment pertaining to ASD.

• Assess the needs of identified beneficiaries and collaborate with providers, caregivers/guardians and others as necessary to ensure treatment is initiated and any barriers are addressed.

• Assess the needs of the family and determine necessary resources to include but not limited to educational programs, community resources, educational materials, and support groups.

• Participate in care management and coordination of services in an effective and efficient manner in accordance with Medical Management policies and procedures.

• Utilize Motivational Interviewing and solution-oriented approaches in communication.

• Work collaboratively with stakeholders across the Enterprise to provide consultative assistance, coordination of services, and participate in integrated care plan meetings as appropriate.

• Develop comprehensive care plans in collaboration with identified stakeholders when appropriate.

• Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible.

• Participates in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD.

• Actively communicate with other ASNs and/or facilitate continuity of care to ensure care transition with beneficiary relocations.

• Assist family in identifying local & or other resources that could benefit the beneficiary to include Respite care for ADFMs.

• Monitor ECHO registration and EFMP enrollment for beneficiaries with qualifying diagnosis, ensuring required documentation is received.

• Maintain provisional list to ensure completion of required application process.

• Follow beneficiary to ensure coordination and approval of services.

• Assess the needs of identified beneficiaries and work collaboratively to ensure care coordination assistance.

• Ensure data is entered accurately and monitor report to make any necessary corrections so that reporting is accurate.

Use your skills to make an impact

Required Qualifications

The Telephonic Care Manager (Autism Care Navigator) must meet ONE of the following license requirements:

• A current, valid, and unrestricted license to include:
  Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist with;

  • Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience.

  • An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.

  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care.

  • Minimum of 1 year of managed care experience.

• OR
  A current, valid, and unrestricted license as a Mental Health (MH) Professional to include:
  Licensed Professional Counselor (LPC), Licensed Clinical Marriage and Family Therapist (LCMFT), Licensed Mental Health Counselor (LMHC) with;

  • Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience.

  • An active designation as a Certified Care Manager (CCM).

  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care.

  • Minimum of 1 year of managed care experience.

• OR
  A current, valid, and unrestricted nursing license to include:
  Registered Nurse (R.N.) with;

  • Must have clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience.

  • Minimum of 3 years of clinical nursing experience.

  • Minimum of 1 year of managed care and case management experience.

  • An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.

The Telephonic Care Manager (Autism Care Navigator) must meet ALL of the following requirements:

• Our Department of Defense Contract requires U.S. citizenship for this position.

• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).

• Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.

• Skilled in written and verbal communications.

• Ability to handle high volume of calls and customer contacts in a polite and professional manner.

• Ability to handle multiple projects simultaneously and to prioritize appropriately.

Preferred Qualifications

• Prior experience with the TRICARE Autism Care Demonstration.

• Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism.

• Direct or Indirect Military experience a plus.

• Extensive analytical skills.

• Bilingual a plus.

Work at Home/Remote Requirements:

• 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.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Work Days/Hours: Monday – Friday; must be able to work an 8 hour shift between 8:00 a.m. – 7 p.m. EST

Training/Training Hours: Mandatory for the first 4 – 6 weeks; 8:00 a.m. – 5:00 p.m. EST

#LI-JB2

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.$59,300 - $80,900 per year. This job is eligible for a bonus incentive plan.

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.

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 veteran status.