Field LTSS Transition & Care Navigator

Humana Inc; Geneva (IL); On-site; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. seeks a Transition/Custodial Prevention Specialist to work with members in their homes, NF facilities, or other member-chosen locations to build personalized care plans and coordinate services.

You will travel regionally to assess goals and connect members with LTSS, HCBS, and community resources, utilizing an interdisciplinary approach. The role emphasizes supporting Medicaid eligibility, care planning, and collaboration with care teams.

Qualifications

• Must reside in the state of Illinois.
• Bachelor's degree in social sciences, social work, human services, or a related field.
• Two (2) years of experience working with Medicare and Medicaid recipients, long-term care services, HCBS, or managed care organizations.
• One (1) or more years of professional experience working with members in custodial and transitional care.
• Experience using a variety of electronic information applications/software programs including electronic medical records.

Responsibilities

• Provide specialized support for LTSS with a focus on health-related social needs (HRSNs) and ensuring LTSS meets the member's service needs.
• Support members in nursing facilities by building relationships with staff and advocating for care, including access to behavioral health services.
• Contact members to establish goals, evaluate resources, develop care plans, and identify LTSS providers and community partnerships.
• Assist members and caregivers through an interdisciplinary approach to access long-term services, housing, education and other services from various funding sources.
• Develop and modify Individual Service Plans with the care team (informal caregiver, PCP, etc.).
• Navigate LTSS and related environmental and social needs for members.
• Use available information to minimize duplicative assessments.
• Make recommendations for Home and Community-Based Services to enable independence.
• Facilitate interactions with payers, providers, and interdisciplinary care teams.
• Educate members on maintaining Medicaid eligibility.
• Enter annual Level of Care assessments into state portals.

Skills

Medicare & Medicaid experience

EMR systems

Travel readiness

Interpersonal communication

Language skills (multilingual)

Education

Bachelor's degree in social sciences, social work, human services, or related field

Tools

Electronic Medical Records (EMR)

Job description

Humana Inc. seeks a Transition/Custodial Prevention Specialist to work with members in their homes, NF facilities, or other member-chosen locations to build personalized care plans and coordinate services.

You will travel regionally to assess goals and connect members with LTSS, HCBS, and community resources, utilizing an interdisciplinary approach. The role emphasizes supporting Medicaid eligibility, care planning, and collaboration with care teams.