The Care Management Support Assistant 3 assists in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services in accordance with the Autism Care Demonstration (ACD). This role supports the Autism Service Navigator (ASN) by coordinating services and researching necessary resources to support the beneficiary and increase access to services; conduct non-clinical outreach to assist families with providers; connect to support groups and other local activities and resources; monitor activated & non-activated referral reports to prioritize beneficiaries for outreach; and direct incoming phone calls to the appropriate ASN to address beneficiary concerns and needs.
Assist ASN with care coordination efforts of assigned beneficiary caseloads to include but not limited to managing incoming & out-going communications by placing calls and or directing the calls to the appropriate personnel and assisting in answering questions.
Identifying available local resources based on beneficiary needs; assists with beneficiary related issues which may include claims inquiries, enrollment issues, travel attestations, access to care, wait lists, coordination of services and other non-clinical beneficiary concerns.
Assist in researching and providing community resources when appropriate. Interface with providers as necessary and appropriate for issue follow-up and resolution. Discuss identified trends with leaders to investigate solutions to improve the beneficiary or provider experience.
Assist with new referrals for the ACD to determine an access to care plan to ensure provider selection and appointment availability; This includes discussing provider options, contacting providers to ensure appointment availability, collaborating with Field Operations to address network inadequacy, and document barriers to care and beneficiary choice for providers with wait lists. Monitor activated & non-activated referral/authorization report to make outbound calls to beneficiaries to ensure appointments are completed within access to care timelines and/or identify reason for delay; documents wait lists and beneficiary choice in waiting for providers as appropriate; collaborate with assigned ASN to address findings; assist beneficiary in locating another provider when necessary; discuss trends with leaders for collaboration with network & non-network partners.
Coordinate and track outcome measure completion to ensure assessments are received by authorization renewal.
Support telephonic customer service functions with beneficiaries throughout the East region with a focus on services provided under the ACD and ECHO as outlined in the TRICARE Operations Manual (TOM), the TRICARE Reimbursement Manual (TRM), and the TRICARE Policy Manual (TPM).
Assist with questions regarding the status of referrals/authorizations for eligible beneficiaries with qualifying ASD diagnoses.
Provide professional and courteous service to all callers and work to resolve any complaint or issue to their satisfaction when possible.
Follow the promise of excellence by adhering to “It is not my fault, but it is my problem” to limit any call transfers to other areas and provide resolution to caller’s needs.
Assist in monitoring ECHO faxes and provisional paperwork to facilitate transition to permanent status. Ensure documentation is accurate and documented in all applicable systems. Be able to communicate ECHO requirements to beneficiaries to ensure they provide necessary paperwork so there are no gaps in care.
Communicates effectively with other departments to coordinate needs of beneficiaries, support the goals of the ACD and exhibits Humana’s values at all times.
This job description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this job description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.
Healthcare professional with a minimum of a Bachelor’s degree in social work, psychology, or related health discipline from an accredited university.
Minimum of 3 years’ experience working in clinics, hospital case management, clinics and/or other healthcare settings.
Above average written and verbal skills, including organizational abilities.
Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook.
Ability to handle multiple projects simultaneously and to prioritize appropriately.
Ability to handle high volume of calls and customer contacts in a polite and professional manner.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing).
Work at Home/Remote Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (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
Masters’ degree in social work, psychology, or related health discipline from an accredited university.
Knowledge of Autism Spectrum Disorder, specifically about Applied Behavior Analysis and other related therapies.
Military health care service experience or working knowledge of TRICARE ACD program.
Direct or Indirect Military experience a plus.
Bilingual a plus.
Work Days/Hours: Monday – Friday; must be able to work an 8 hour shift between 8:00 a.m. – 7 p.m. EST.
Training/Training Days & Hours: Mandatory for the first 4 – 6 weeks; Monday – Friday, 8:00 a.m. – 4:00 p.m. EST.
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.
Scheduled Weekly Hours