Care Management Support Assistant 2 ACD Referral Coordinator

Profile

Description

Responsibilities

The Care Management Support Assistant 2- ACD Referral Coordinator-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD Referral Coordinator performs varied activities with a focus on administrative and customer support assignments. Typical work involves processing referrals into medical management system with emphasis on accuracy and timeliness. During high volume calling times the ACD RC will monitor the phone queues and web chats to answer provider/beneficiary inquiries. The Care Management Support Assistant 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The ACD Referral Coordinator duties include data entry into medical management system, eligibility reviews, reviewing for ECHO benefits, non-clinical overview of assessments and documentation in order to pend tasks to appropriate queues who can complete or request additional information.

Role Responsibilities

Recognizes specific assessments/treatment plans requiring Utilization Management, and pend to appropriate point of contact for review.

Understands TRICARE ACD benefits/limitations and Humana Military referral processes.

Answers questions from CM's, Outreach Coordinators or MTF/ civilian providers to obtain additional information that may be required to complete referral etc.

Requires understanding of Tricare policy on Autism Care Demonstration. Decisions are focused on ACD department policy and methods for completing assignments.

Works within defined parameters to maintain production and quality standards, with ability to prioritize certain referrals.

Works under minimal direction.

Required Qualifications

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) .

Two years prior healthcare/insurance experience

Above average written and verbal skills, including organizational abilities

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

Computer experience including data entry

Ability to handle multiple projects simultaneously and to prioritize appropriately

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

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Bachelor's Degree

Knowledge of Autism Spectrum Disorder, specifically about Applied Behavior Analysis and other related therapies

Military health care service experience or working knowledge of TRICARE ACD program

Direct or Indirect Military experience a plus

Bilingual a plus

Additional Information

The following policy applies ONLY to associates working in the state of Arizona : Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter .

Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift between 8:00 am - 7pm EST.

Training/Training Hours : Mandatory for the first 4 - 6 weeks; 8:00am - 4:00pm EST

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com