Become a part of our caring community and help us put health first
Humana Healthy Horizons in Ohio is seeking a Care Guide/Care Guide Plus (Care Coach 1) who will assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness state. The Care Guide serves as a single point of contact for care coordination for members who are not assigned to a Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact at the MCO for care coordination when there is Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Connects members to CCEs, the OhioRISE Plan, or MCO Care Management if the member's needs indicate a higher level of coordination.
You will be part of a caring community at Humana.
When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.
Are you Caring, Curious and Committed? If so, apply today!
This position employs a variety of strategies, approaches, and techniques to manage a member's health issues.
- Identifies and resolves barriers that hinder effective care
- Ensures member is progressing towards desired outcomes by continuously monitoring care through use of assessment, data, and conversations with member/member representative
- Assesses and evaluates member's needs via telephonic and face to face assessments and evaluations, to coordinate services and address member short term needs
- Assures completion of an HRA or other assessments
- Assists members to remediate immediate and acute gaps in care and access
- Assists members with filing grievances and appeals
- Provides information to members related to MCO requirements, services, and benefits
- Provides members with information and/or referrals to community resources
- Coordinates services, and monitoring and evaluating the care coordination plan against the member's personal goals and identified needs
- Guides members/families towards resources appropriate for their care
- Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member’s care as appropriate
- Work assignments are often straightforward and of moderate complexity
- Makes decisions regarding own work approach/priorities and follows direction
- Understands own work area professional concepts/standards, regulations, strategies, and operating standards
- Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation
Use your skills to make an impact
Required Qualifications:
- Must reside in Ohio
- Must be able to travel 50% within the state of Ohio to meet with members
- Minimum one (1) year of care coordination experience
- Minimum one year intermediate or better of working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word, with the ability to troubleshoot and resolve general technical difficulties
- Strong understanding and respect of all cultures and demographic diversity
- Exceptional interpersonal skills with the ability to quickly build rapport
- Strong written and verbal communication skills
- Strong advocate for members at all levels of care
- This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Preferred Qualifications:
- Bachelor's degree in Social Work, Sociology, Psychology, Gerontology or related field
- Community Health Worker Certification
- Prior experience with Medicaid, Medicare or dual eligible populations
- Experience with health promotion, coaching and wellness
- In home assessment and care coordination experience
- Knowledge of community health and social service agencies and additional community resources
- Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems
- Bilingual (Spanish, Somali or other) Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in assessed languages
Additional Information
- Work Style: Remote with travel to see members (see below for Travel information).
- Workdays/Hours: Monday – Friday; 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.
- Travel: 50% travel within state to meet members and to Humana Healthy Horizons office location in Dublin, OH for staff meetings and training. Leader will discuss during the interview.
About Humana
Your growth is what drives Humana forward.
- When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you.
- This is a place where our nurses influence the C-suite.
- Where software engineers change lives.
- Where every associate can build a professional path where they learn and thrive.
- Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
- Because finding new ways to put health first—for our members and patients and our associates alike—is what we do.
Work at Home Guidance
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
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
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.
$47,700 - $65,600 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.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
