Job Description: Humana at Home Delegated Field Care Manager
Humana At Home is Humana’s investment in helping members remain when faced with medical and functional challenges. Humana has a long history of advocating for high quality affordable care – particularly for older and disabled populations. Humana’s vision, robust health programs and technology contribute to the high quality services we provide members identified as most at risk. These services lead to the following outcomes:
• Have the means to obtain medications, understand what medications to take and know how to take them.
• Understand self-care requirements and be able to implement them.
• Have access to helpful resources as needed.
• Be able to access PCP care and follow- up as required.
• Be able to remain at home and avoid unnecessary ER visits and hospitalizations.
• Will understand their medical conditions/disease processes and know when to seek assistance for any red flags.
Role: Delegated Field Care Manager (DFCM)
This role is for either an independent contractor or an employee of a Care Management practice or agency contracting with Humana At Home.
• Engaging Humana members in a collaborative relationship which empowers the member to manage his or her physical, environmental and psycho-social health issues, improve and maintain lifelong wellbeing and remain at home
• Providing “best-in-class” care management to Humana’s most vulnerable member, the frail elderly, the complex chronically ill and the functionally challenged, to identify risks, gaps in care and prevent unnecessary hospitalizations and emergency room visits
• The DFCM will work with three In-Home models:
• The 30 day Transitions Service involves working with the member for 30 days post-discharge from a hospital or sub-acute facility and consists of three in-person Care Management visits with the member; coordination with PCP, identification of and advocacy for community and Humana resources and telephonic contact to ensure adherence to treatment plan.
• Long Term in Home Care consists of weekly in-person Care Management visits with the member, coordination with PCP, identification of and advocacy for community and Humana resources and telephonic contact to ensure adherence to treatment plan.
• In-Home Surveys are at the request of a telephonic care manager or another Humana Associate to identify a concern about the member i.e. Area of Focus that could be best evaluated in a one-time face to face visit.
The DFCM may also be involved from time to time in special pilots programs that focus on unique needs of a certain member population. These pilots are based on the above models.
• Computer Skills and Resources:
o Private Computer with access to accommodate data entry within required timelines
o Ability to use a variety of electronic information applications/software programs including electronic medical records
o Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel
o Excellent keyboard and web navigation skills
o High speed internet connectivity (DSL or cable modem; recommended speed is 10Mx1M for optimal performance).
o Registered Nurse
o Licensed Social Workers (Each state has the responsibility of determining the titles professionals can use and the scope of practice they are allowed) Clinical social workers are always licensed. In most states, master’s level social workers are licensed whether or not they are in clinical practice. Many states also license baccalaureate social workers. Consult www.socialwork liscensure.org to determine the State’s requirement.
o LPN or LVN (when authorized by the Director of the Care Management Network)
o Certified Case Manager (CCM)
o Care Manager Certification
• Valid driver’s license, car insurance, and access to an automobile for home visits to member
• Job Experience:
o Must be licensed minimum of one year with at least one year confirmed work experience under license.
o Previous Care Management/Case Management/Managed Care experience preferred or
o Previous Community based or In-Home visit experience preferred or
o Previous experience working with Geriatric, chronically ill or functionally challenged populations
Preferred Skills, Attributes and Available Resources
• Excellent verbal and written communication skills
• Strong organizational skills, including time management, consistent follow up, and attention to detail
• Analytic and strategic thinking abilities to support solution based approach to addressing gaps in care and problems
• Experience with Motivational Interviewing and Coaching skills
Job Duties (will include, but are not limited to):
• In-home visits with member
• Hospital/facility visits
• Facilitating conference calls between the member, the physician and the care manager as needed to clarify treatment plans, medication regimens or other urgent issues
• Reconciling prescribed medication
• Assessing members’ environment, functioning, psycho social status and financial well-being
• Identifying and developing action plans to empower members to remain and thrive at home
• Connecting members and their families with approved resources, services and professional intervention within Humana and in their community who can help them address medical, legal, housing, insurance and financial issues
• Providing member and their family/caregivers with educational material and coaching to empower them to manage their health and well being
Confident, Autonomous, Self-starter Problem solver, Solution-driven, Prepared, Organized, Detail oriented, High standards of excellence, Educated, Compassionate, Objective, Non-judgmental, Resourceful, Kind, Caring, Team Player, Team builder, Open minded, Sense of humor, Intuitive, Dedicated, Creative, Responsive, Proactive, Good business savvy, Good communicator, Understands family dynamics, Emotionally intelligent, Able to maintain professional boundaries, Maintains HIPAA compliance, Knows when to consult manager.
• If you are employed by an agency or practice contracting with Humana at Home, you report operationally to your supervisor or manager
• If you are an independent contractor you are responsible for all human resource and operational management.
• All DFCMs are responsible to work with assigned Humana At Home Long Term in Home or Transitions Clinical Managers to achieve service level standards for all members.
• All DFCMs are responsible for following the guidelines for documentation, billing and payment outlined by the Humana at Home Care Management Network Department.
Humana At Home