Transition/Custodial Prevention Specialist

Humana; Waterman (IL); On-site; USD 52,000 - 70,000; Full time

Job summary

Humana seeks a Transition/Custodial Prevention Specialist to work one-on-one with members, building personalized care plans, coordinating services, and empowering greater independence. The role emphasizes LTSS, HRSNs, and community resource navigation to promote meaningful health outcomes.

You will meet members in homes, NF facilities, or at their chosen location, collaborating with care teams to design and implement person-centered plans.

Qualifications

• Must reside in Illinois.
• Bachelor's degree in social sciences, social work, human services, or related field.
• Two years of experience with Medicare/Medicaid, HCBS, or managed care.
• One year or more of custodial and transitional care experience.
• Experience with electronic information applications/EMR systems.
• Ability to travel within the region to meet members and families.

Responsibilities

• Provide LTSS-focused support addressing health-related social needs and psychosocial support.
• Engage with Nursing Facility staff, advocate for member care, and assist community re-entry goals.
• Meet with members in homes or preferred locations to assess goals, needs, and barriers; develop care plans.
• Identify LTSS providers and community partnerships to coordinate services.
• Guide members and caregivers through navigation of LTSS, housing, and other services across funding sources.

Skills

Empathy

Communication

Travel flexibility

Interdisciplinary collaboration

Education

Bachelor's degree in social sciences or related field

Tools

Electronic Medical Records

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.

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.

This position will support members within the catchment 2 area which includes Kane and DeKalb counties.

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