Field Care Manager, Behavioral Health (RN, LCSW, CSW, LSW, LPC)

The BH CM must perform the full scope of care coordination activities and responsibilities for members who need care coordination and are notassigned to a Care Coordination Entity, the OhioRISE Plan, and/or a Care Management Entity, or who choose to receive their care management from the MCO. The BH CM would serve as the single point of contact for care coordination.

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The BH CM Plus must ensure the completion of the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a Care Coordination Entity, the OhioRISE Plan, CPCs, and/or a Care Management Entity. Care Manager Plus serves as the single point of contact for care coordination.

• Ensuring the member receives the full scope of care coordination services, including comprehensive assessment completion (inclusive of the HRA), person-centered care plan completion, ensuring no duplication with the CCEs (Ohio RISE Plan, and/or CME), and identifying and addressing ongoing needs.
• Providing actionable data, information, and support to assist the CCE, OhioRISE Plan, and/or CME in meeting the member's care needs
• Integrating information collected by the external Care Coordination Entities into the Care Coordination Portal to minimize duplication of efforts.

Position Responsibilities:

The Field Care Manager, 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.

• Performs telephonic and face to face assessments and evaluations of the member’s needs and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
• Ensures member is progressing towards desired outcomes by continuously monitoring care through assessments and/or evaluations.
• Creates member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Collaborates with providers and community services to promote quality and cost-effective outcomes.
• Ensures the delivery of needed services/supports for Behavioral Health, Physical Health, Social Determinant of Health and value added benefits.
• Coordinates across the transdisciplinary care team and with the PCP and supports transitions of care.
• Submits incident reports.

• Must reside in Ohio.
• Preferred location; South Central/ South East Ohio
• Must have a Child and Adolescent Needs & Strengths (CANS) certification or able to obtain one within 60 days of hire.
• Applicable state licensure in field of study with no disciplinary action: Licensed Masters Clinical Social Worker (LCSW), Clinical Social Worker (CSW), Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), or Registered Nurse (RN).
• Minimum of 2 years of post-degree clinical experience in a behavioral health setting.
• Case management experience.
• This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least100,000/300,000/100,000limits.

Preferred Qualifications:

• Case Management Certification (CCM).
• Experience working with Medicare, Medicaid and dual-eligible populations.
• Field Case Management Experience.
• Health Plan experience.
• Knowledge of community health and social service agencies and additional community resources.
• Experience with health promotion, coaching and wellness.
• Bilingual (Spanish, Somali or other).

About Humana

Your growth is what drives Humana forward.

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
• This is a place where our nurses influence the C-suite.
• Where software engineers change lives.
• Where every associate can build a professional path where they learn and thrive.
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
• Because finding new ways to put health firstfor our members and patients and our associates alikeis what we do.

Additional Information

• Workstyle: Combination remote work at home and onsite member facing.
• Hours: 40 hour work week Monday through Friday 8:00 AM 5:00 PM Eastern, over-time may be requested as business needs.
• Travel: Must be willing to commute about 50% to meet with members. More information will be provided during the interview.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office 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 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

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 or computer 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.