Transition/Custodial Prevention Specialist

Humana; Illinois; On-site; USD 59,000 - 81,000; Full time

Job summary

Humana seeks a Transition/Custodial Prevention Specialist to work in the Illinois region, meeting members in homes or facilities to develop care plans and connect with community services. The role emphasizes LTSS, HRSNs, and person-centered planning with a focus on independence.

The position requires travel within the region, collaboration with care teams, and expertise in HCBS, Medicaid eligibility, and community resources. Eligible for a bonus plan; field-based with 40-hour work weeks.

Qualifications

• Residency in Illinois.
• Bachelor's degree in social sciences, social work, human services, or related field.
• Two years of experience with Medicare/Medicaid recipients, LTSS, HCBS, or managed care.
• One+ year of experience with custodial and transitional care.
• Experience with electronic medical records.
• Ability to travel regionally to meet members and families.

Responsibilities

• Provide LTSS support focusing on health-related social needs (HRSNs) and ensuring LTSS meets member service needs.
• Build relationships with facility staff, advocate for member care, and assess the ability to return to the community.
• Contact members to set goals, evaluate resources, develop plans of care, and identify LTSS providers.
• Work with an interdisciplinary team to access long term services and supports across social, housing, education and other services.
• Develop and modify Individual Service Plans with care team involvement (informal caregiver coach, PCP, etc.).
• Support members in navigating LTSS and related environmental and social needs.
• Avoid duplicative assessments by utilizing available information.
• Recommend Home and Community-Based Services to promote independence.
• Facilitate interactions with payers, providers, and care teams.
• Educate members on maintaining Medicaid eligibility.
• Assist with annual Level of Care assessments in the state portal.

Skills

Travel ability

Interdisciplinary collaboration

Education

Bachelor's degree in social sciences / social work / human services

Licensed professional counselor (LPC) / licensed social worker (LSW) / registered nurse (RN) in IL

Tools

Electronic Medical Records

Electronic information systems

Job description

Become a part of our caring community

Are you passionate about helping others navigate healthcare and community resources? As a Transition/Custodial Prevention Specialist, you will work one-on-one with members to create personalized care plans, coordinate services, and empower them to achieve better health outcomes and greater independence. You will meet members in the field at home, Nursing Facility (NF), or location of the member's choice. You will spend quality time assessing their goals, needs, and barriers. Then, you will connect members with quality services to promote their ultimate well-being and drive person-centered health outcomes.

• Provide specialized support for members receiving Long Term Services and Support (LTSS), with a focus on addressing health-related social needs (HRSNs), providing psychosocial support, and ensuring LTSS meets the member's service needs.
• Support members residing in NFs by building relationships with facility staff, advocating for member care (including access to needed behavioral health services), and assessing the member's desire and ability to return to the community.
• Contact members telephonically and face-to-face to establish goals and priorities, evaluate resources, develop plans of care, and identify LTSS providers and community partnerships to provide a combination of services and supports that best address the needs and goals of members and caregivers through person centered thinking approaches.
• Focus on supporting members or caregivers utilizing an interdisciplinary approach in accessing long term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs.
• Develop and modify Individual Service Plans and involve applicable members of the care team in care planning (Informal caregiver coach, PCP, etc.).
• Support members through navigation of their LTSS and related environmental and social needs.
• Utilize available information pertaining to members to prevent the need for administration of duplicative assessments.
• Make recommendations for appropriate Home and Community-Based Services (HCBS) to enable member's independence in the community.
• Facilitate interactions with other payer sources, providers, and interdisciplinary care teams.
• Educate members in maintaining Medicaid eligibility.
• Assist with entry of annual Level of Care assessment into state portal.

Required Qualifications

Use your skills to make an impact

• 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, Home and Community-Based 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.
• Ability to travel in the region to meet face-to-face with members and/or their families, community partners and care teams.

Preferred Qualifications

• An active, unrestricted Licensed Professional Counselor (LPC), Licensed Social Worker (LSW) or Registered Nurse (RN) in Illinois.
• Nursing home diversion or long-term care case management experience.
• Experience working with a Waiver Program.
• Experience with Medicare & Medicaid recipients.
• Experience working with complex health population.
• Experience with health promotion, coaching and wellness.
• Knowledge of community health and social service agencies and additional community resources.
• Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other.

Additional Information

• Workstyle/Travel: This is a Field position that requires 75 - 90% travel in the field to visit members. May need to attend occasional onsite meetings in Humana's Schaumburg, IL office.
• Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Central Standard Time (CST), with flexibility available. Additional hours may be required based on business needs.

Driving

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state's driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

TB

This 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 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.

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. This incentive opportunity is based upon company and/or individual performance.

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 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 atHumana.comand atCenterWell.com.

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 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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.