Become a part of our caring community
Join our team in this exciting role as Residential Adult Family Home (AFH) Certifier. Reporting to the Supervisor of Provider Engagement, you will oversee the certification of new and existing 1-2 bed adult family homes in iCare/Humana network. You will cultivate our social community through community advocacy programs and active engagement with community members. You will travel throughout Southwestern WI working with our providers.
In this role you will:
Sustain positive working relationships with team members and provide excellent customer service to certified 1-2 bed Adult Family Home (AFH) providers to support the vision for residential transformation.
Ensure compliance with the Medicaid Standards for Certified 1-2 Bed Adult Family Homes during the certification and recertification of assigned AFH's. Screen provider documentation to check eligibility to become certified.
Independently complete Adult Family Home certification process for all new homes in assigned region of the network.
Annually re-certify all certified AFH's in assigned service region, maintaining timely and thorough completion of all necessary documentation.
Verify and document that you correct all cited areas of non-compliances or areas of the standards that you must bring into compliance before you issue a certification.
Maintain experience of the Medicaid Standards for Certified 1-2 Bed Adult Family Homes and DHS contract language about certified AFH expectations for providers and MCO staff.
Lead efforts around any provider plans of correction, terminations or revocation of certification.
Ensure a network of certified adult family homes that increases community connections, supports member choice and dignity, and fosters full participation in communities.
Participate in ongoing training; maintain up-to-date knowledge to ensure compliance with Medicaid Standards and organizational practices.
Must travel within assigned region to complete certifications and recertification's. Ability to visit homes on an emergent basis.
Use your skills to make an impact
Required Qualifications
Bachelor's degree
1 year of experience understanding the requirements for Residential Providers.
Must reside within the State of WI or commutable to Southwest, WI within approximately 30 mins
Able to travel 50-60% of your time throughout Southwest, WI region
Preferred Qualifications
1 or more years of experience in Managed Care
Knowledge of Medicaid standards for 1-2 bed Adult Family Homes and all related and reference standards.
Additional Information
Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.
Work Location: Southwest Wisconsin
Travel: up to 50-60% throughout coverage area
Hours: Monday through Friday, 8:00 am - 4:30 pm CST
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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.
$58,700 - $70,400 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at?Humana.com?and at?CenterWell.com.
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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.
