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The Care Management Support Assistant 3 assists in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services in accordance with the Autism Care Demonstration (ACD). This role supports the Autism Service Navigator (ASN) by coordinating services and researching necessary resources to support the beneficiary and increase access to services; conduct non-clinical outreach to assist families with providers; connect to support groups and other local activities and resources; monitor activated & non-activated referral reports to prioritize beneficiaries for outreach; and direct incoming phone calls to the appropriate ASN to address beneficiary concerns and needs.
The Care Management Support Assistant 3 responsibilities include:
Assist ASN with care coordination efforts of assigned beneficiary caseloads to include but not limited to managing incoming & out-going communications by placing calls and or directing the calls to the appropriate personnel and assisting in answering questions.
Identifying available local resources based on beneficiary needs; assists with beneficiary related issues which may include claims inquiries, enrollment issues, travel attestations, access to care, wait lists, coordination of services and other non-clinical beneficiary concerns.
Assist in researching and providing community resources when appropriate. Interface with providers as necessary and appropriate for issue follow-up and resolution. Discuss identified trends with leaders to investigate solutions to improve the beneficiary or provider experience.
Assist with new referrals for the ACD to determine an access to care plan to ensure provider selection and appointment availability; This includes discussing provider options, contacting providers to ensure appointment availability, collaborating with Field Operations to address network inadequacy, and document barriers to care and beneficiary choice for providers with wait lists. Monitor activated & non-activated referral/authorization report to make outbound calls to beneficiaries to ensure appointments are completed within access to care timelines and/or identify reason for delay; documents wait lists and beneficiary choice in waiting for providers as appropriate; collaborate with assigned ASN to address findings; assist beneficiary in locating another provider when necessary; discuss trends with leaders for collaboration with network & non-network partners.
Coordinate and track outcome measure completion to ensure assessments are received by authorization renewal.
Support telephonic customer service functions with beneficiaries throughout the East region with a focus on services provided under the ACD and ECHO as outlined in the TRICARE Operations Manual (TOM), the TRICARE Reimbursement Manual (TRM), and the TRICARE Policy Manual (TPM).
Assist with questions regarding the status of referrals/authorizations for eligible beneficiaries with qualifying ASD diagnoses.
Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible.
Follow the promise of excellence by adhering to "It is not my fault, but it is my problem" to limit any call transfers to other areas and provide resolution to caller's needs.
Assist in monitoring ECHO faxes and provisional paperwork to facilitate transition to permanent status. Ensure documentation is accurate and documented in all applicable systems. Be able to communicate ECHO requirements to beneficiaries to ensure they provide necessary paperwork so there are no gaps in care.
Communicates effectively with other departments to coordinate needs of beneficiaries, support the goals of the ACD and exhibits Humana's values at all times.
Use your skills to make an impact
Required Qualifications
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS).
HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
Healthcare professional with a minimum of a Bachelor's degree in social work, psychology and/or related health discipline from an accredited university.
Minimum of 3 years' experience working in clinics, hospital case management, managed care settings, Autism services and/or other healthcare settings.
Above average written and verbal communication skills.
Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.
Strong organizational skills with the ability to handle multiple projects simultaneously and to prioritize appropriately.
Ability to handle a 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.
The ability to work an 8-hour shift Mon-Fri between the hours of 8 a.m. to 7 p.m. EST.
Preferred Qualifications
Masters' degree in social work, psychology, or related health discipline from an accredited university.
Knowledge of Autism Spectrum Disorder, specifically about Applied Behavior Analysis and other related therapies.
Military health care service experience, experience working onsite at a Military treatment facility (MTF) and/or working knowledge of TRICARE ACD program.
Direct or Indirect Military experience a plus.
Bilingual a plus.
Experience working in a remote/work at home setting.
Additional Information
Work Days/Hours : Monday - Friday; must be able to work an 8-hour shift between 8:00 a.m. - 7 p.m. EST.
Training/Training Days & Hours : Mandatory for the first 4 - 6 weeks; Monday - Friday, 8:00 am - 4:00 pm EST.
Work Style : Remote
Work at Home/Remote Requirements
To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$40,000 - $52,300 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
Application Deadline: 09-05-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
