Job Description: Humana At Home Network Field Care Manager
This role is for an independent contractor or an employee of a Care Management practice or agency contracting with Humana At Home.
Humana At Home is Humana’s investment in helping members remain at home when faced with medical and functional challenges. Humana has a long history of advocating for high quality affordable care – particularly for our members who need extra support to succeed at home. Humana’s vision, robust health programs and technology contribute to the high quality services we provide members.
Care Management services will help Humana members:
Be empowered to maintain their wellbeing in the comfort and familiarity of their own homes.
Avoid unnecessary ER visits and hospitalizations
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 and a support network as needed
Access PCP care and follow- up as required
Understand the benefits of preventative health care and keeping regular appointments with their PCP
Engage Humana members in a collaborative relationship which empowers the member to manage his or her physical, environmental and psycho-social health issues, to improve and maintain lifelong wellbeing and remain at home.
In-home visits with member
Hospital/facility visits when authorized by Humana
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, functional, 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
Completing required paperwork and documentation within the timeframe required
Collaboration with other Humana associates, disciplines and participation on interdisciplinary rounds
Maintaining professional care management responsibilities by setting appropriate boundaries,complying with CM Network expectations and productivity standards, and seeking managerial consult as needed
Strategic and analytic thinking to address gaps in care
Provide “best-in-class” complex care management to Humana’s most vulnerable members, the frail elderly, the chronically ill and the functionally challenged
Identify risks, gaps in care and prevent unnecessary hospitalizations and emergency room visits by developing an individualized interdisciplinary plan of care for members and families to follow in order to achieve life long well being in the home
Educate the member on preventative health care
Comply with all onboarding, annual and other mandatory trainings as assigned.
Collaborate with other members of the “care team” including members’ physicians and Humana clinical associates
Maintain HIPAA compliance
Educate on resources to assist with medication reconciliation and understanding of medical conditions
The Network Field Care Manager 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 two in-person Care Management visits with the member; medication reconciliation, coordination with Primary Care Physician (PCP), referral to community resources and ensure adherence to interdisciplinary plan of care.
Long-Term In-Home Care consists of weekly or twice a month 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 happen at the request of a telephonic Care Manager or another Humana Associate to identify a member’s problem area, i.e. area of focus, that could be best evaluated in a one-time face to face visit.The Network Field Care Manager 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.
Licensed Registered Nurse must have at least one year of post graduate relevant case management experience.
Licensed Social Worker (Licensure for both baccalaureate and master’s level social worker’s will be determined by state guidelines) In most states, master’s level social workers are able to be licensed whether or not they are in clinical practice. Many states also license baccalaureate social workers. Consult www.socialworkliscensure.org to determine the State’s requirement. Licensed Social Workers must have at least one year of post graduate relevant case management experience. BA or MA level Social Workers who are not licensed will be considered on a case by case basis by Humana At Home Management. They must have a minimum of two years of relevant care/case management experience.
LPN or LVN must have a minimum of 3 years of relevant care/case management experience.
Certified Care/Case Manager (CMC/CCM) with at least two years of relevant care/case management experience will also be considered on a case by case basis by Humana At Home Management.
Other related disciplines such as Nurse Practitioners, Licensed Professional Counselors, Professionals with a BA or MA in Gerontology, Professionals with a BA or MA in Psychology, Sociology, Mental Health Counseling and Human Services and Counseling will be considered based on their level of relevant experience on a case by case basis by Humana At Home Management.
Complex Care Management/Case Management/Managed Care experience
Community based or In-Home visit experience
Experience working with either Geriatric, chronically ill or functionally challenged populations
Computer skills and resources:
Ability to use a variety of electronic information applications/software programs, electronic medical records experience
Intermediate to Advanced computer skills and proficiency with Microsoft Word,Outlook, and Excel, excellent keyboard and web navigation skills
Access to a secure computer in order to accommodate data entry within required timelines
High speed internet connectivity (DSL or cable modem; recommended speed is 10Mx1M for optimal performance)
Valid driver’s license, car insurance, and access to an automobile for home visits to member is required
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, strong communicator, understands family dynamics, professional.
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 Network Field Care Managers are required to work with assigned Humana At Home Long-Term In-Home or Transitions Clinical Managers to achieve service level standards for all members
All Network Field Care Managers are responsible for following the guidelines for documentation; billing and payment outlined by the Humana At Home Care Management Network Department
Humana at Home