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.
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
- Bachelor's degree in health and human services field
- 2 or more years of related experience
- Knowledge of Microsoft Office Word and Excel
- Exceptional verbal/written communication and interpersonal skills
- Ability to use a variety of electronic information applications/software programs
- This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- This role is 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
Prior experience with Medicare & Medicaid recipients
- Previous experience with electronic case note documentation and experienced with documenting in multiple computer applications/systems
- Experience with health promotion, coaching and wellness
- Knowledge of community health and social service agencies and additional community resources
Additional Information
As part of our hiring process for this opportunity, we will be using an 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.
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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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
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.
$53,700 - $72,600 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.
