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

Humana Healthy Horizons in Ohio is seeking a Care Guide/Care Guide Plus (Care Coach 1) who will assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness state. The Care Guide serves as a single point of contact for care coordination for members who are not assigned to a Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact at the MCO for care coordination when there is Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Connects members to CCEs, the OhioRISE Plan, or MCO Care Management if the member's needs indicate a higher level of coordination.

This position employs a variety of strategies, approaches, and techniques to manage a member's health issues.

• Identifies and resolves barriers that hinder effective care.
• Ensures member is progressing towards desired outcomes by continuously monitoring care through use of assessment, data, and conversations with member/member representative.
• Assesses and evaluates member's needs via telephonic and face to face assessments and evaluations, to coordinate services and address member short term needs.
• Assures completion of an HRA or other assessments.
• Assists members to remediate immediate and acute gaps in care and access.
• Assists members with filing grievances and appeals.
• Provides information to members related to MCO requirements, services, and benefits.
• Provides members with information and/or referrals to community resources.
• Coordinates services, and monitoring and evaluating the care coordination plan against the member's personal goals and identified needs.
• Guides members/families towards resources appropriate for their care.
• Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member’s care as appropriate.
• Work assignments are often straightforward and of moderate complexity.
• Makes decisions regarding own work approach/priorities and follows direction.
• Understands own work area professional concepts/standards, regulations, strategies, and operating standards.
• Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Use your skills to make an impact
 

Required Qualifications

• Must reside in Ohio.
• Must be able to travel 50% within the state of Ohio to meet with members.
• Minimum one (1) year of care coordination experience.
• Familiarity using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word systems, platforms, and an ability to troubleshoot and resolve general technical difficulties.
• Strong understanding and respect of all cultures and demographic diversity.
• Exceptional interpersonal skills with the ability to quickly build rapport. 
• Strong written and verbal communication skills.
• Strong advocate for members at all levels of care.
• 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 least 100,000/300,000/100,000 limits.
• Must have the ability to provide a high speed DSL or cable modem for a home office.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications: 

• Bachelor's degree in Social Work, Sociology, Psychology, Gerontology or related field.
• Community Health Worker Certification.
• Prior experience with Medicaid, Medicare or dual eligible populations.
• Experience with health promotion, coaching and wellness.
• In home assessment and care coordination experience. 
• Knowledge of community health and social service agencies and additional community res