FCP Case Manager

Humana; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

Humana/iCare is seeking a Case Manager to join the GSR3 team in the Family Care Partnership program in Milwaukee and surrounding counties. The role focuses on assessment, service plan development, and ongoing care coordination for adults with disabilities and the frail elderly.

Responsibilities include psychosocial assessments, resource identification, care plan updates, advocacy, and collaboration with family, members, and medical professionals. Travel up to 75% is required.

Qualifications

• Cases management and psychosocial assessment skills.
• Understanding of Medicaid/Medicare benefits.
• Ability to travel within service area and document care.
• Familiarity with care coordination workflows and audits.

Responsibilities

• Conduct psychosocial assessments as part of the comprehensive assessment process.
• Coordinate and monitor services and resources to meet member outcomes.
• Update care plans and monitor member health and safety.
• Assist member or rep with complaints, grievances and advocacy.
• Document member information and contacts per policy and procedures.
• Create documentation according to policy, workflows, audits and timeframes.
• Build working relationships with member, family and outside staff.
• Coordinate care with physicians and medical professionals.
• Educate member and providers on benefits and resources; provide referrals.
• Monitor engagement in treatment and explore alternatives with staff and providers.

Skills

Case management

Psychosocial assessment

Medicaid/Medicare knowledge

Travel readiness

Documentation

Education

Bachelor's degree in Human Services

Bachelor's degree in any field with 3+ years Family Care experience

Wisconsin Social Work Certification/Licensure

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. Share your talents and develop your skills all while doing your part to improve the lives of others.

Responsibilities

• Conduct psychosocial assessments as part of the comprehensive assessment process.
• 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.
• Coordinate and monitor services and resources implemented to meet member's identified outcomes and member's progress toward meeting those outcomes.
• 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.
• Build constructive working relationships with the member, their family members, and appropriate outside agency staff.
• Facilitate collaboration with the member's physician or appropriate medical professionals to coordinate member's care.
• Assist in problem resolution between member and providers.
• 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.
• Monitor member's ability and willingness to engage in treatment regimes, and work with staff, member and providers to find alternatives or solutions to their needs.

Required Qualifications

The Case Manager must meet one of the following qualifications:

• 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: Frail Elders, Physically Disabled, or Intellectually/Developmentally Disabled***
• 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.

Preferred Qualifications

• Certification or Licensure in Social Work in the State of Wisconsin or be eligible for Certification and Licensure.
• Previous managed care experience.
• General knowledge of Medicaid and Medicare benefits.

Additional Information

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; 8:30am - 5:00 pm (CST)

DrivingThis 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. Eligible mileage includes: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.

TB ScreeningThis role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

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 reser