Case Manager

Humana/iCare is seeking a Case Manager to join the growing GSR3 team in the Family Care Partnership (FCP) program. The FCP Case Manager/Care Coach provides care management services through the FCP program including assessment, service plan development, ongoing care coordination, quality assurance and ongoing monitoring of services to adults with disabilities and the frail elderly.

Responsibilities:

• Conduct psychosocial assessments as part of the comprehensive assessment process.
• Utilize the Resource Allocation Decision making methodology (RAD), help member identify their preferred outcomes and potential strategies to achieve those outcomes, including through the identification of community resources and cost-effective services or equipment.
• Coordinate and monitor services and resources implemented to meet member's identified outcomes and member's progress toward meeting those outcomes.
• Conduct periodic reassessment and updates of the member's care plan and monitor member's health and safety.
• Assist member or member's representative in filing complaints, grievances and obtaining advocacy services.
• Document member information and contacts made regarding member's care and services provided.
• Create documentation according to policy and procedure, workflows, audit requirements and time frames.
• Build constructive working relationships with the member, their family members, and appropriate outside agency staff.
• Facilitate collaboration with the member's physician or appropriate medical professionals to coordinate member's care.
• Assist in problem resolution between member and providers.
• Educate member and providers regarding benefits, service providers and protocols to access resources and the appropriate use of medical services. Provide referrals for community resources and social services as necessary.
• Monitor member's ability and willingness to engage in treatment regimes, and work with staff, member and providers to find alternatives or solutions to their needs.

Required Qualifications:

• Social Worker certified in Wisconsin with a minimum of one (1) years' working with at least one of the Family Care target group populations.
• 4-year bachelor's degree or more advanced degree in the Human Service area and a minimum of one (1) years' experience working with at least one of the Family Care target populations.
• 4-year bachelor's degree or more advanced degree in any area other than human services with a minimum of three (3) years' experience working with at least one of the Family Care populations.
• Knowledge of the community resources available to meet the needs of the members and a thorough understanding of the range and type of long term care options available in the community.
• Ability to travel to any location within Milwaukee, Walworth, Racine/Kenosha, Waukesha, Washington, Ozaukee, Sheboygan Counties to conduct assessments within members' residences.

Preferred Qualifications:

• Certification or Licensure in Social Work in the State of Wisconsin or be eligible for Certification and Licensure.
• Previous managed care experience.
• General knowledge of Medicaid and Medicare benefits.

Additional Information:

• Workstyle: Field. Field workstyle is defined as associates performing their core duties at one or more non-Humana/iCare locations.
• Travel: up to 75% of the time
• Typical Work Days/Hours: Monday through Friday; 8:30am – 5:00 pm (CST)
• Driving: This role is 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 least 100/300/100 limits.
• Mileage reimbursement is provided for work-related travel.
• TB Screening: This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Scheduled Weekly Hours: 40

Pay Range: $53,700 - $72,600 per year

Description of Benefits: Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.