FCP Case Manager

Humana; Town of King (WI); Remote; USD 54,000 - 78,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off and holidays

Job summary

Humana iCare is seeking a Case Manager to join the Family Care Partnership (FCP) team across Milwaukee, Racine, Kenosha, Walworth, Waukesha, Washington, Ozaukee and Sheboygan counties. You will assess, plan and coordinate services for adults with disabilities and the frail elderly, using the RAD methodology to identify outcomes and cost-effective resources.

You’ll collaborate with health professionals, educate members and caregivers about benefits, and create compliant documentation while

Qualifications

• Wisconsin Social Worker certification and/or eligibility for certification/licensure
• Bachelor’s degree in Human Services with 1+ year experience with Family Care target populations
• Bachelor’s degree in any field with 3+ years experience working with Family Care populations
• Ability to travel up to 75% to Milwaukee, Racine, Kenosha, Waukesha, Washington, Ozaukee, Sheboygan counties and conduct home assessments
• Previous managed care experience preferred

Responsibilities

• Reassess and update the member’s care plan; monitor health and safety
• Assist member or representative with complaints, grievances and advocacy services
• Document member information and care interactions per policy and audit requirements
• Coordinate with physicians and medical professionals to manage member care
• Educate members and providers on benefits, services and resource access; arrange community referrals

Skills

Social Work Certification

Field work

Education

B.A. in Human Services

B.A. in any field with 3+ years experience with Family Care

Job description

Become a part of our caring community

Humana/iCare is seeking a Case Manager/ to join the growing GSR3 team (Milwaukee, Racine, Kenosha, Walworth, Waukesha, Washington, Ozaukee, Sheboygan) in the Family Care Partnership (FCP) program. The FCP Case Manager/Care Coach provides care management services through the FCP program including assessment, service plan development, ongoing care coordination, quality assurance and ongoing monitoring of services to adults with disabilities and the frail elderly. Utilize the Resource Allocation Decision making methodology (RAD), help member identify their preferred outcomes and potential strategies to achieve those outcomes, including through the identification of community resources and cost-effective services or equipment.

• Conduct periodic reassessment and updates of the member's care plan and monitor member's health and safety.
• Assist member or member's representative in filing complaints, grievances and obtaining advocacy services.
• Document member information and contacts made regarding member's care and services provided.
• Create documentation according to policy and procedure, workflows, audit requirements and time frames.
• Facilitate collaboration with the member's physician or appropriate medical professionals to coordinate member's care.
• Educate member and providers regarding benefits, service providers and protocols to access resources and the appropriate use of medical services. Provide referrals for community resources and social services as necessary.

• Social Worker certified in Wisconsin with a minimum of one (1) years' working with at least one of the Family Care target group populations.
• 4-year bachelor's degree or more advanced degree in the Human Service area and a minimum of one (1) years' experience working with at least one of the Family Care target populations.
• 4-year bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care populations. ***The Family Care target group population is defined as: Knowledge of the community resources available to meet the needs of the members and a thorough understanding of the range and type of long term care options available in the community.
• Ability to travel to any location within Milwaukee, Walworth, Racine/Kenosha, Waukesha, Washington, Ozaukee, Sheboygan Counties to conduct assessments within members' residences.

Certification or Licensure in Social Work in the State of Wisconsin or be eligible for Certification and Licensure.

Previous managed care experience.

Workstyle: Field. Field workstyle is defined as associates performing their core duties at one or more non-Humana/iCare locations.

Travel: up to 75% of the time.

Typical Work Days/Hours: Monday through Friday; This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.

Mileage reimbursement is provided for work-related travel. Travel from your home to your first work location of the day. Travel between client or assignment locations during the workday. Travel from your final work location back to your home.

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: wireless, wired cable or DSL connection is suggested. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

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 Humana: Humana Inc. (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.

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.