Care Management Support Assistant - Remote Eligible

Care Management Support Assistant 2

Become a part of our caring community and help us put health first. The Care Management Support Assistant 2 supports the Autism Care Demonstration (ACD). ACD Referral Coordinator (RC) will process referrals from Military Treatment Facilities and civilian providers for the ACD program. The ACD RC performs varied activities with a focus on administrative and customer support assignments. Typical work involves processing referrals into the medical management system with emphasis on accuracy and timeliness. During high volume calling times the ACD RC will monitor the phone queues and secure messaging to answer provider/beneficiary inquiries. The ACD RC performs varied activities and moderately complex administrative/operational/customer support assignments. The Care Management Support Assistant 2 contributes to administration of care management, utilization management, and daily operations. The ACD RC duties include data entry into medical management system, eligibility reviews, reviewing for ECHO benefits, non-clinical overview of assessments and documentation to pend tasks to appropriate queues who can complete or request additional information. Provides non-clinical support to the assessment by answering questions, evaluating beneficiaries needs, identifying problems and possible solutions, and routing calls appropriately. This role requires flexibility in tasks and assignments due to fluctuating volume and business needs.

Key Accountabilities:

• Recognizes ACD specific assessments/treatment plans and pends referrals and authorizations to appropriate point of contact for review. Understands TRICARE ACD benefits/limitations per the TRICARE Operations Manual and the Humana Military referral processes.
• Coordinates authorizations with Autism Services Navigators and Utilization Management according to established HUMANA GOVERNMENT BUSINESS contract standards and guidelines to include timely referral processing. Answers questions from associates and MTF/civilian providers to obtain additional information that may be required to complete referrals. Monitors timeliness in the medical management authorization system to ensure referrals are pended within 24 hours.
• Answer inbound calls on the TRICARE Autism Care Demonstration utilizing available resources. Identifies call and call inquiry. Documents calls through the customer service documentation system in accordance with established guidelines for all incoming calls. Educates beneficiaries and providers regarding the TRICARE ACD program, consistently providing complete and accurate information; demonstrates thorough knowledge of all TRICARE plans and eligibility for ACD benefits.
• Demonstrates complex problem solving ability utilizing analytical skills, and deductive reasoning skills in order to process and interpret data from multiple sources. Consistently recognizes, promotes, and delivers quality customer service to ensure accomplishment of departmental and government goals. Customer service is defined as internal and external stakeholders.

Use your skills to make an impact.

Required Qualifications:

• Our Department of Defense contract requires U.S. Citizenship.
• Successfully receive interim approval for government security clearance.
• Must be able to work a shift of 10:30 a.m. - 7 p.m. E.T. to help handle internal phone queue.
• Medical terminology experience and/or UM/Coding Experience.
• 3 years experience in customer service or referral management position.
• 3 years of experience in healthcare/medical or health insurance field.

Preferred Qualifications:

• Military health care service experience or working knowledge of TRICARE entitlement program.
• Bachelor's degree.

Work at Home Requirements:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours: 40

Pay Range: $39,000 - $49,400 per year

Description of Benefits: Humana, Inc. offers competitive benefits that support whole-person well-being. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance and many other opportunities.

About Us: Humana Inc. 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.

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 protected veteran status. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.