Become a part of our caring community and help us put health first
 

This role involves meeting members in the field at their home, Nursing Facility (NF) or location of the member's choice, spending quality time assessing their goals, needs and barriers and then connecting our members with quality services to promote their ultimate well-being and drive person centered health outcomes.

Position Responsibilities:

• Initial Home Visit and Care Planning
• Member and Employer of Record (EOR) Training
• Timesheet and Service Verification
• Documentation and Compliance
• Ongoing Support and Monitoring
• Annual Medicaid Waiver Redetermination
• Availability and Member Support
• Back-Up Planning and Service Continuity
• Internal Collaboration
• Quality Assurance and Risk Management

Use your skills to make an impact
 

Required Qualifications:

• Bachelor's degree in a health and human service field (such as Social Work, Nursing, Public Health, Psychology, or Human Services) OR LPN OR equivalent relevant direct care experience.
• Minimum of one year of experience in service facilitation or in a community-based setting supporting individuals with disabilities, children, or older adults.
• Must reside in Virginia (preferably Roanoke, upper Charlottesville, Harrisonburg and Winchester)
• The company requires successful completion of DMAS-approved service facilitator training and competency assessment within 90 days of hire. The minimum score for this assessment is 80%. Additionally, the employee must pursue ongoing recertification every five years. To do so, they must provide current certification.
• Proficiency in service facilitation best practices, including comprehensive understanding of Virginia state law and federal regulations related to Medicaid waivers and consumer-directed services. Familiarity with DMAS forms 97 AB, 98, 99, 100, 486, 488, 489, and FARF.
• Demonstrated competencies in assessing functional limitations, care planning, interviewing, documentation, cultural competence, and independent work.
• Commitment to privacy, safety, and compliance standards in accordance with corporate policies and all applicable federal and state regulations. Ability to manage confidential information with discretion and integrity, in compliance with HIPAA and organizational privacy standards.
• Experience working with electronic systems and proficiency in Microsoft Office applications, including Excel, Word, PowerPoint, and Teams.
• Maintain up-to-date personnel records, including documentation of all training, competency assessments, professional references, and background checks.
• Ensure completion and retention of criminal background checks and the Virginia Department of Social Services Child Protective Services Central Registry
• Verify that candidates are not debarred, suspended, or excluded from participation in federal healthcare programs, as confirmed through the LEIE database.
• Obtain/Maintain a notary public commission within 90 days of employment.

Preferred Qualifications:

• Bilingual proficiency in English and another language.
• Experience working with Medicaid or managed care populations.
• Familiarity with Humana's electronic health record systems.
• Certification in case management (such as CCM, ACM, or equivalent) or progress toward such certification.
• Previous experience in telehealth or virtual care coordination environments

Additional Information

Workstyle: Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.

Workdays and Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs and requires approval.

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.

Travel, Driver's License, Transportation, Insurance: Must be willing to travel at least 30-50% of the time within your assigned Region where you reside in Northern Virginia, to conduct field visits with members in your assigned area. Travel requirements may vary based on member tier level. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA.

Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided