Humana

About Humana

 

Job Category:

Integrated Care & Care Operations - Care Management

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Care Manager, Telephonic Behavioral Health 2

Humana - Work At Home, Florida

Posted: 09/23/2018

Description

The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Care Manager, Telephonic Behavioral Health 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Role Responsibilities

This is a clinical case management position with responsibilities for administering clinical case management programs for the Humana Behavioral Health (HBH) TRICARE team.  As an HBH TRICARE team member, you represent Humana Military which is both Humana Behavioral Health (HBH) and Humana Government Business (HGB) jointly working together to administer the TRICARE benefit.  Tasks include, but are not limited to:

  • Perform telephonic case management with beneficiaries throughout the United States with a focus upon behavior change.
  • Complete consultations, referrals, and assessments for beneficiaries with qualifying co-occurring disorders/illnesses in collaboration with Humana Government Business (HGB).
  • Participate in case management services in an effective and efficient manner in accordance with HBH TRICARE Clinical Department and Program Policy and Procedures.
  • Assess the needs of identified beneficiaries and work with providers and HGB counterparts to develop an individualized plan of care and provide care coordination assistance to beneficiaries, guardians and providers.
  • Ensure all policies and performance standards in accordance with the URAC, TRICARE Operations Manual (TOM), TRICARE Provider Manual (TPM) or any other Defense Health Agency (DHA) directive are followed.
  • Serve as a Humana Military/HBH liaison to TRICARE beneficiaries, guardians, personal care managers and providers.
  • Utilize Motivational Interviewing and Solution-Oriented approaches in communication.
  • Identify community resources to provide services
  • Provide various services as an adjunct to treatment plan and interventions.
  • Adhere to URAC standards, state and federal regulations and individual licensing boards.
  • Attend and participate in scheduled clinical case staffing to include Front Line Leader, peers and HBH TRICARE Medical Directors.
  • Close cases efficiently and appropriately as indicated by beneficiary completing established goals.
  • Participate in professional development activities.
  • Educated in current principles, procedures, and knowledge domains of case management based on nationally recognized standards.
  • Participate in on call functions for Elite Behavioral Health Cases as necessary.
  • Other tasks as assigned.

Our Department of Defense Contract requires U.S. citizenship for this position

               

Role Essentials

  • Mental Health professional with a master’s degree in a behavioral-health field, such as social work, psychology, or related health discipline from an accredited university
  • Must have a current valid unrestricted license such as: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Psychologist (PhD), or other equivalent professional license in the state where you reside
  • Minimum of 3 years of post-degree clinical experience in private practice or other patient care
  • Minimum of 1 year of managed care experience
  • CCM certification required or must obtain within 1 year
  • Trained and experience in managing mental health clinical crisis

Role Desirables

  • Direct or Indirect Military experience a plus

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
 
If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone
and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you
will be moving forward to next round of interviews.


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)

Scheduled Weekly Hours

40

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