Care Management Support Assistant
Humana
Become a part of our caring community and help us put health first
The Care Management Support Assistant 2- supports the Autism Care Demonstration (ACD). ACD Referral Coordinator (RC)-will process referrals from Military Treatment Facilities (MTFs) and civilian providers for the ACD program. The ACD RC performs varied activities with a focus on administrative and customer support assignments. Typical work involves processing referrals into the medical management system with emphasis on accuracy and timeliness. During high volume calling times the ACD RC will monitor the phone queues and secure messaging to answer provider/beneficiary inquiries. The ACD RC performs varied activities and moderately complex administrative/operational/customer support assignments. The Care Management Support Assistant 2 contributes to administration of care management, utilization management and daily operations. The ACD RC duties include data entry into medical management system, eligibility reviews, reviewing for ECHO benefits, non-clinical overview of assessments and documentation to pend tasks to appropriate queues who can complete or request additional information.
Provides non-clinical support to the assessment by answering questions, evaluating beneficiaries needs, identifying problems and possible solutions, and routing calls appropriately. This role requires flexibility in tasks and assignments due to fluctuating volume and business needs.
Key Accountabilities -
Recognizes ACD specific assessments/treatment plans and pend referrals and authorizations to appropriate point of contact for review. Understands TRICARE ACD benefits/limitations per the TRICARE Operations Manual (TOM) Chapter 18, section 3 and the Humana Military referral processes per the TOM Chapter 7 section 5. Works within defined parameters to maintain production and quality standards, with ability to prioritize certain referrals and/or authorizations.
Coordinates authorizations with Autism Services Navigators and Utilization Management according to established HUMANA GOVERNMENT BUSINESS contract standards and guidelines to include timely referral processing. Answers questions from associates and MTF/ civilian providers to obtain additional information that may be required to complete referrals. Monitors timeliness in the medical management authorization system to ensure referrals are pended within 24 hours.
Answer inbound calls on the TRICARE Autism Care Demonstration utilizing available resources. Identifies call and call inquiry. Documents calls through the customer service documentation system in accordance with established guidelines for all incoming calls. Educates beneficiaries and providers regarding the TRICARE ACD program, consistently providing complete and accurate information; demonstrates thorough knowledge of all TRICARE plans and eligibility for ACD benefits.
Demonstrates complex problem solving ability utilizing analytical skills, and deductive reasoning skills in order to process and interpret data from multiple sources. Consistently recognizes, promotes, and delivers quality customer service to ensure accomplishment of departmental and government goals. Customer service is defines as internal and external stakeholders.
Use your skills to make an impact
Required Qualifications
Our Department of Defense contract requires U.S. Citizenship
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
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.
Must be able to work a shift of 10:30 a.m. - 7 p.m. E.T. to help handle internal phone queue
Medical terminology experience and/or UM/Coding Experience
3 years experience in customer service or referral management position (handling high volume of work with a deadline)
3 years of experience in healthcare/medical or health insurance field
Preferred Qualifications
Military health care service experience or working knowledge of TRICARE entitlement program
Bachelor's degree
Work at Home Requirements
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
Scheduled Weekly Hours
40Pay 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.
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.
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.