Care Coordinator

Become a part of our caring community
Join Humana Gold Plus Integrated as a Care Coordinator and make a meaningful impact on the lives of Illinois Medicaid Members. As a Care Coordinator supporting Humana's Illinois Health Choice Medicaid Managed Care program, you will play a vital role in helping members achieve their best possible health and well-being. Reporting to the Manager, Care Management, you will assess member's unique needs, develop personalized care plans, and connect individuals and families with the resources and support they need to thrive.

If you are passionate about helping others navigate their healthcare journey and creating lasting change, we encourage you to apply.
Upon hire, you will be assigned to support either MLTSS or LTSS based on business needs.

The Care Coordinator responsibilities are as follows:

• Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long-Term Care Facilities and other care settings – 75%-90% local travel.
• Ensure members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
• Identify and resolve barriers that hinder effective care.
• Plan and implement interventions to meet care needs.
• Coordinate services, monitor, and evaluate the case management plan against the member's personal goals.
• Ensure the patient is progressing towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with members, and active care planning.
• Assess and evaluate enrollee's needs via telephonic and face to face assessments and evaluations, to coordinate services and address enrollee needs.
• Assist enrollee to remediate immediate and acute gaps in care and access.
• Assist enrollee with filing grievances and appeals.
• Provide information to enrollee related to MCO requirements, services, and benefits.
• Provide enrollee with information and/or referrals to community resources.
• Guide 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 and required by our comprehensive contract.

Use your skills to make an impact

Required Qualifications

The Care Coordinator must meet one (1) of the following requirements:

• Bachelor's degree in social sciences, social work, human services, or a related field.
• Unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one (1) year experience conducting comprehensive assessments and provision of formal service for the elderly.
• Licensed Professional Counselor (LPC).
• Licensed Social Worker (LSW).

The Care Coordinator must meet all following requirements:

• Must reside in the state of Illinois.
• 1+ years of experience in health care and/or case management.
• 1+ years of experience with Medicare & Medicaid recipients and/or long-term care and/or Home and Community based services and/or working with managed care organizations.
• Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
• Experience using a variety of electronic information applications/software programs including electronic medical records.

Additional Information

• Workstyle/Travel: This is a Field position that requires 75 - 90% travel in the field to visit members.
• Schedule: Monday - Friday 8am - 5pm CST but open to flexible work schedule. Possibility of working additional hours based on business needs.

Driving

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

TB

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.

Work at Home Requirements:
To ensure Home or Hybrid Home/Office…