Telephonic Care Manager

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