Location
Cincinnati, OH, United States
Posted on
Feb 03, 2022
Profile
Job Information
Humana
Telephonic Care Manager
in
Cincinnati
Ohio
Description
The Telephonic Care Manager will be part of the Humana Military Case Management team; providing a comprehensive, holistic approach for Behavioral Health Case Management throughout the continuum of care. They will have personal interaction with beneficiaries to address behavioral health needs and conditions identified through direct referrals, predictive analytics, or diagnosis triggers, helping them to address immediate care needs, treatment plan adherence, and develop coping skills.
Responsibilities
The Case Manager will assess, plan, coordinate, implement, monitor, and evaluate the care needs of TRICARE beneficiaries over the phone, to maximize each beneficiary's capacity for self-care to enhance their quality of life and achieve desired clinical outcomes.
As part of the Case Management team, the case manager will serve as the primary point of contact and coordinator for the beneficiary for all activities within the clinical spectrum. This will include coordination and collaboration with Military Treatment Facilities (MTF), other Care Management programs (such as Disease Management and Utilization Management), physicians, staff, or providers to ensure there is a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the Case Management program. Performs all duties within the scope of his/her licensure.
Role Responsibilities
Assess, plan, coordinate, implement, monitor, and evaluate medical / behavioral health services required to meet the complex health needs of TRICARE beneficiaries by developing a personalized plan of care from assessment findings in coordination with the beneficiary's physician and care team.
Coordinate, review, and approve medically necessary, appropriate care within the guidelines of the TRICARE program to ensure the health needs of the beneficiary are met.
Provide telephonic care guidance and support to beneficiaries and their family/caregiver to ensure education, care coordination and support measures are in place; according to the established plan of care.
Identify gaps in care, eligibility for assistance and/or need for care management program or other referral services in collaboration with Humana Government Business.
Utilize Motivational Interviewing and solution-oriented approaches in communication delivery
Identify Social Determinants of Health needs and/or community resources to provide services
Maintain beneficiary's privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
Ensure adherence to policies and performance standards in accordance with the URAC, TRICARE Operations Manual (TOM), TRICARE Provider Manual (TPM) or any other Defense Health Agency (DHA) directives.
OUR DEPARTMENT of DEFENSE Contract Requires U.S. citizenship for this position
Required Qualifications
The Telephonic Care Manager must meet ONE
of the following requirements:
A current, valid and unrestricted license as a Registered Nurse (R.N.)
Bachelor's degree in Nursing
Behavioral Health Experience
OR
A current, valid, and unrestricted license as a Mental Health (MH)/Behavioral Health (BH) Professional to include: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Mental Health Counselor (LMHC), Licensed Masters Social Worker (LMSW), Clinical Psychologist (Ph.D.).
The Telephonic Care Manager must meet ALL
of the following requirements:
3 or more years of clinical or managed care experience
An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.
Experience in managing mental health crisis intervention.
Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.
Excellent written and verbal communication skills.
Excellent organizational skills.
Ability to handle calls and member contacts in a polite and professional manner.
Ability to handle multiple tasks simultaneously and to prioritize appropriately.
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).
We will require
full COVID vaccination
for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
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
Bilingual fluent in Spanish, English
Experience with Medical/Behavioral Health Case Management Programs
Direct or Indirect Military experience a plus.
Experience with motivational interviewing techniques
Additional Information
Work Days/Hours
: Monday - Friday; must be able to work an 8 hour shift between 8:00 a.m. - 6 p.m. EST.
Training/Training Hours
: Mandatory for the first 4 weeks; 8:00 a.m. - 5:00 p.m. EST
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
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