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The Telephonic Care Manager (Autism Care Navigator) serves as a primary advocate for assigned beneficiaries receiving care under the Autism Care Demonstration (ACD). The ASN (Autism Care Navigator) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Coordinate medical, behavioral and other services for beneficiaries with a primary diagnosis of ASD, as defined by the ACD.
The Telephonic Care Manager (Autism Care Navigator) serves as a Humana Military liaison to TRICARE beneficiaries, providers and others involved in the care planning for beneficiaries receiving services under the TRICARE program.
Role Responsibilities
Serves as 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; notify & provide copy of CCP to providers & parents/caregivers; ensure all baseline measures are completed as required by ACD policy; 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.
Participates in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD. The conversation should revolve around coordination of services and ensuring goals are appropriate and not in conflict to the treatment plans by any other services received by the beneficiary. Team conferences for complex beneficiaries with ASD and other co-occurring conditions that impact services being successful in the management of ASD. Ensures providers comply with attendance and policies outlined in the TOM for conferences. Serve as meeting facilitator, created documented summary of meeting minutes and share copy with stakeholders.
Actively communicate with other ASNs and/or facilitate continuity of care to ensure care transition with beneficiary relocations (regions and or markets).
Assist family in identifying local & or other resources that could benefit the beneficiary to include Respite care for ADFMs.
Monitor ECHO registration and EFMP enrollment for beneficiaries with qualifying diagnosis, ensuring required documentation is received.
Maintain provisional list to ensure completion of required application process.
Follow beneficiary to ensure coordination and approval of services.
Assess the needs of identified beneficiaries and work collaboratively to ensure care coordination assistance.
Ensure data is entered accurately and monitor report to make any necessary corrections so that reporting is accurate.
Use your skills to make an impact
Required Qualifications
The Telephonic Care Manager (Autism Care Navigator) must meet ONE of the following license requirements:
A current, valid, and unrestricted license to include:
Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist with;
Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management 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
Minimum of 1 year of post-degree clinical experience in private practice or other patient care
Minimum of 1 year of managed care experience
OR
A current, valid, and unrestricted license as a Mental Health (MH) Professional to include:
Licensed Professional Counselor (LPC), Licensed Clinical Marriage and Family Therapist (LCMFT), Licensed Mental Health Counselor (LMHC) with;
Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience
An active designation as a Certified Care Manager (CCM)
Minimum of 1 year of post-degree clinical experience in private practice or other patient care
Minimum of 1 year of managed care experience
OR
A current, valid, and unrestricted nursing license to include:
Registered Nurse (R.N.) with;
Must have clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience
Minimum of 3 years of clinical nursing experience
Minimum of 1 year of managed care and case management 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
The Telephonic Care Manager (Autism Care Navigator) must meet ALL of the following requirements:
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)
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.
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
Preferred Qualifications
Prior experience with the TRICARE Autism Care Demonstration
Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism
Direct or Indirect Military experience a plus
Extensive analytical skills
Bilingual a plus
Work at Home/Remote Requirements :
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office 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 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
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 Hours: Mandatory for the first 4 - 6 weeks; 8:00 a.m. - 5:00 p.m. EST
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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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.
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.
