Humana

Compensation

Full Description

Job Description: • Serve as a 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. • Participate in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD. Requirements: • 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. • 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. Benefits: • medical, dental and vision benefits • 401(k) retirement savings plan • paid time off • company and personal holidays • volunteer time off • paid parental and caregiver leave • short-term and long-term disability • life insurance • many other opportunities