Become a part of our caring community and help us put health first
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.
The Telephonic 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.
Use your skills to make an impact
Required Qualifications
In your state of residency, you must have a current, valid, and unrestricted license as a Mental Health (MH)/Behavioral Health (BH) Professional in at least ONE of the following: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Mental Health Counselor (LMHC), Licensed Masters Social Worker (LMSW) AND/OR Clinical Psychologist (Ph.D.) .
3 or more years of clinical, which may include managed care experience.
Ability to obtain a Certified Care Manager (CCM) within the first year of hire.
Experience in managing mental health crisis intervention.
Proficiency in Microsoft Office programs specifically; Word, Excel, OneNote 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 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 **.
Preferred Qualifications**
An active designation as a Certified Care Manager (CCM).
Experience in Acute inpatient hospital case management.
Experience with Medical/Behavioral Health Case Management Programs.
Direct or Indirect Military experience a plus.
Experience with TRICARE policies and/or the military health care delivery system.
Experience with motivational interviewing techniques.
Bilingual fluent in Spanish, English.
Additional Information
Work Style : Remote
Work Schedule : Monday - Friday; must be able to work an 8-hour shift between the hours of 8:00 a.m. - 6 p.m. EST (Eastern Standard Time)
Training/Training Hours : Mandatory for the first 4 weeks between the hours 8:00 a.m. - 5:00 p.m. EST (Eastern Standard Time)
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.
$59,300 - $80,900 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.
Application Deadline: 02-12-2026
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.
