Humana is committed to putting health first and is seeking a Case Manager for their Racine/Kenosha County team in the Family Care Partnership program. The Case Manager will provide care management services, including assessments, care coordination, and support for adults with disabilities and the frail elderly.
Responsibilities
- Conduct psychosocial assessments as part of the comprehensive assessment process
- Utilize the Resource Allocation Decision making methodology (RAD), help member identify their preferred outcomes and potential strategies to achieve those outcomes, including through the identification of community resources and cost-effective services or equipment
- Coordinate and monitor services and resources implemented to meet member’s identified outcomes and member’s progress toward meeting those outcomes
- Conduct periodic reassessment and updates of the member’s care plan and monitor member’s health and safety
- Assist member or member’s representative in filing complaints, grievances and obtaining advocacy services
- Document member information and contacts made regarding member’s care and services provided
- Create documentation according to policy and procedure, workflows, audit requirements and time frames
- Build constructive working relationships with the member, their family members, and appropriate outside agency staff
- Facilitate collaboration with the member’s physician or appropriate medical professionals to coordinate member’s care
- Assist in problem resolution between member and providers
- Educate member and providers regarding benefits, service providers and protocols to access resources and the appropriate use of medical services. Provide referrals for community resources and social services as necessary
- Actively monitor member’s ability and willingness to engage in treatment regimes, and problem solve with staff, member and providers to find alternatives or solutions to their needs
Skills
- Social Worker certified in Wisconsin with a minimum of one (1) years' experience working with at least one of the Family Care target group populations
- 4-year bachelor's degree or more advanced degree in the Human Service area and a minimum of one (1) years' experience working with at least one of the Family Care target populations
- 4-year bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care populations
- Knowledge of the community resources available to meet the needs of the members and a thorough understanding of the range and type of long term care options available in the community
- Ability to travel to any location within Racine and Kenosha Counties to conduct assessments within members' residences
- Previous experience working with Microsoft Outlook, Word, Teams, and Excel
- Certification or Licensure in Social Work in the State of Wisconsin or be eligible for Certification and Licensure
- Previous managed care experience
- General knowledge of Medicaid and Medicare benefits
Benefits
- Medical
- Dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
Company Overview
Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.
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