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Humana · 1 day ago

Care Manager, Telephonic Behavioral Health

United States

Full-time

Remote

Mid Level

$59K/yr - $81K/yr

3+ years exp

Humana is a healthcare company committed to putting health first. The Care Manager, Telephonic Behavioral Health serves as a primary advocate for beneficiaries, coordinating care and services for individuals with Autism Spectrum Disorder (ASD) and ensuring comprehensive health needs are met.

Health CareHealth InsuranceInsuranceVenture Capital

No H1B

U.S. Citizen Only

Responsibilities

Serves as primary advocate for beneficiary & family collaborating with other CMs to coordinate care activities; conduct assessment for development of comprehensive care plan (CCP); update CCP at least every 6 months; complete PSI or SIPA as indicated; notify & provide copy of CCP to providers & parents/caregivers; ensure all baseline measures are completed as required by ACD policy; administer &/or collect outcome measures as defined by ACD policy, provide outcome measure data to respective providers; serve as POC for MTF CMs

Perform telephonic care management with beneficiaries throughout the East region with a focus of coordination of services for any treatment pertaining to ASD

Assess the needs of identified beneficiaries and collaborate with providers, caregivers/guardians and others as necessary to ensure treatment is initiated and any barriers are addressed

Assess the needs of the family and determine necessary resources to include but not limited to educational programs, community resources, educational materials, and support groups

Participate in care management and coordination of services in an effective and efficient manner in accordance with Medical Management policies and procedures

Utilize Motivational Interviewing and solution-oriented approaches in communication

Work collaboratively with stakeholders across the Enterprise to provide consultative assistance, coordination of services, and participate in integrated care plan meetings as appropriate

Develop comprehensive care plans in collaboration with identified stakeholders when appropriate

Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible

Participates in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD. The conversation should revolve around coordination of services and ensuring goals are appropriate and not in conflict to the treatment plans by any other services received by the beneficiary. Team conferences for complex beneficiaries with ASD and other co-occurring conditions that impact services being successful in the management of ASD. Ensures providers comply with attendance and policies outlined in the TOM for conferences. Serve as meeting facilitator, created documented summary of meeting minutes and share copy with stakeholders

Actively communicate with other ASNs and/or facilitate continuity of care to ensure care transition with beneficiary relocations (regions and or markets)

Assist family in identifying local & or other resources that could benefit the beneficiary to include Respite care for ADFMs

Monitor ECHO registration and EFMP enrollment for beneficiaries with qualifying diagnosis, ensuring required documentation is received

Maintain provisional list to ensure completion of required application process

Follow beneficiary to ensure coordination and approval of services

Assess the needs of identified beneficiaries and work collaboratively to ensure care coordination assistance

Ensure data is entered accurately and monitor report to make any necessary corrections so that reporting is accurate

Qualification

Registered Nurse (RN)Licensed Clinical Social WorkerClinical experience in ASDCare management experienceCertified Care Manager (CCM)Microsoft Office proficiencyWrittenHigh volume call handlingMulti-project prioritizationBilingualVerbal communication

Required

Active unrestricted Registered Nurse, (RN) license without disciplinary action with the following: Minimum three, (3) years of clinical experience in: pediatrics, behavioral health, and/or ASD; healthcare environment; including managed care experience

OR Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist unrestricted license as a Mental Health (MH) Professional Licensed Professional Counselor (LPC), Licensed Clinical Marriage and Family Therapist (LCMFT), Licensed Mental Health Counselor (LMHC) with the following: Clinical experience in pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience

Minimum of 1 year of post-degree clinical experience in private practice or other patient care

Minimum of 1 year of managed care experience

Our Department of Defense Contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Obtain designation as a Certified Care Manager (CCM) within first year of hire

Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook

Skilled in written and verbal communications

Ability to handle high volume of calls and customer contacts in a polite and professional manner

Ability to handle multiple projects simultaneously and to prioritize appropriately