Remote Telephonic Care Manager, RN, Metairie, LA

Humana

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Location:Metairie, LA
Location Type: Metairie – Remote
Schedule: Full_time
Req: R-311226

Description

 

The Telephonic Care Manager (Autism Care Navigator) serves as a primary advocate for assigned beneficiaries receiving care under the Autism Care Demonstration (ACD). The ASN (Autism Care Navigator) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Coordinate medical, behavioral, and other services for beneficiaries with a primary diagnosis of ASD, as defined by the ACD.

 

Responsibilities

 

The Telephonic Care Manager (Autism Care Navigator) serves as a Humana Military liaison to TRICARE beneficiaries, providers and others involved in the care planning for beneficiaries receiving services under the TRICARE program.

 

Role Responsibilities

  • Serves as primary advocate for beneficiary & family collaborating with other CMs to coordinate care activities; conduct assessment for development of comprehensive care plan (CCP); update CCP at least every 6 months; notify & provide copy of CCP to providers & parents/caregivers; ensure all baseline measures are completed as required by ACD policy; collect outcome measures as defined by ACD policy, provide outcome measure data to respective providers; serve as POC for MTF CMs.
  • Perform telephonic care management with beneficiaries throughout the East region with a focus of coordination of services for any treatment pertaining to ASD.
  • Assess the needs of identified beneficiaries and collaborate with providers, caregivers/guardians and others as necessary to ensure treatment is initiated and any barriers are addressed.
  • Assess the needs of the family and determine necessary resources to include but not limited to educational programs, community resources, educational materials, and support groups.
  • Participate in care management and coordination of services in an effective and efficient manner in accordance with Medical Management policies and procedures.
  • Utilize Motivational Interviewing and solution-oriented approaches in communication.
  • Work collaboratively with stakeholders across the Enterprise to provide consultative assistance, coordination of services, and participate in integrated care plan meetings as appropriate.
  • Develop comprehensive care plans in collaboration with identified stakeholders when appropriate.
  • Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible.
  • Participates in Coordinated Team Conferences; includes medical team conferences involving three or more providers rendering care to beneficiaries with ASD under the ACD.  The conversation should revolve around coordination of services and ensuring goals are appropriate and not in conflict to the treatment plans by any other services received by the beneficiary. Team conferences for complex beneficiaries with ASD and other co-occurring conditions that impact services being successful in the management of ASD. Ensures providers comply with attendance and policies outlined in the TOM for conferences. Serve as meeting facilitator, created documented summary of meeting minutes and share copy with stakeholders.
  • Actively communicate with other ASNs and/or facilitate continuity of care to ensure care transition with beneficiary relocations (regions and or markets).
  • Assist family in identifying local & or other resources that could benefit the beneficiary to include Respite care for ADFMs.
  • Monitor ECHO registration and EFMP enrollment for beneficiaries with qualifying diagnosis, ensuring required documentation is received.
  • Maintain provisional list to ensure completion of required application process.
  • Follow beneficiary to ensure coordination and approval of services.
  • Assess the needs of identified beneficiaries and work collaboratively to ensure care coordination assistance.
  • Ensure data is entered accurately and monitor report to make any necessary corrections so that reporting is accurate.

               

Required Qualifications

The Telephonic Care Manager (Autism Care Navigator) must meet ONE of the following license requirements:

 

A current, valid, and unrestricted license to include:
Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Clinical Psychologist with;

  • Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience
  • An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire
  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience

OR
A current, valid, and unrestricted license as a Mental Health (MH) Professional to include:
Licensed Professional Counselor (LPC), Licensed Masters Social Worker (LMSW), Licensed Clinical Marriage and Family Therapist (LCMFT), Licensed Mental Health Counselor (LMHC) with;

  • Clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience
  • An active designation as a Certified Care Manager (CCM)
  • Minimum of 1 year of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience

OR
A current, valid, and unrestricted nursing license to include:
Registered Nurse (R.N.) with;

  • Must have clinical experience in: pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience
  • Minimum of 3 years of clinical nursing experience
  • Minimum of 1 year of managed care and case management experience
  • An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire

The Telephonic Care Manager (Autism Care Navigator) must meet ALL of the following requirements:

  • Our Department of Defense Contract requires U.S. citizenship for this position
  • Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)
  • Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook
  • Skilled in written and verbal communications
  • Ability to handle high volume of calls and customer contacts in a polite and professional manner
  • Ability to handle multiple projects simultaneously and to prioritize appropriately

Work at Home/Remote Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • 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 and computer 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

Preferred Qualifications

  • Prior experience with the TRICARE Autism Care Demonstration
  • Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism
  • Direct or Indirect Military experience a plus
  • Extensive analytical skills
  • Bilingual a plus

Additional Information

Work Days/Hours: Monday – Friday; must be able to work an 8 hour shift between 8:00 a.m. – 5 p.m. EST or your reflective time zone.
Training/Training Hours: Mandatory for the first 4 – 6 weeks; 8:00 a.m. – 5:00 p.m. EST
Work Style: Remote

 

Interview Format:
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

 

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

 

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

 

This is a remote position
#LI-Remote

 

Scheduled Weekly Hours

 

40