Humana

Location: Must reside in region 6 Hillsborough or Polk County Florida The Pediatric Care Manager employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.. ECC CM help to reduce duplication of efforts, ease transitions of care, limit gaps between service providers, and secure transportation or other support / enabling services.. Preferred Qualifications A good understanding of AHCA regulations, NCQA and Medicaid guidelines Managed care experience Certified Case Manager (CCM) Bilingual Creole or Spanish Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability.. Job Type: Full-time Pay: $70,000.00 - $96,200.00 per year Benefits: 401(k) 401(k) matching Dental insurance Employee discount Flexible spending account Health insurance Health savings account Life insurance Paid time off Parental leave Retirement plan Tuition reimbursement Vision insurance Schedule: 8 hour shift Monday to Friday Supplemental pay types: Bonus opportunities Application Question(s): REQUIRED - Do you reside in Hillsborough or Polk County Florida?. YES/NO Experience: Pediatric acute care: 3 years (Required) Pediatric RN, LPN or LCSW: 3 years (Required) Ability to Relocate: Hillsborough County, FL: Relocate before starting work (Required) Willingness to travel: 25% (Required) Work Location: In person

care manager

The Pediatric Care Manager, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Location: Must reside in region 6 Hillsborough or Polk County Florida The Pediatric Care Manager employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.  Identifies and resolves barriers that hinder effective care.  Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.  May create member care plans.  Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.  Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.  Follows established guidelines/procedures. Enhanced Care Coordination (ECC) ECC helps to connect children diagnosed with but not limited to Chronic medical conditions, congenital conditions, developmental disabilities, and learning disabilities to care services. The ECC Case Manager (CM) assists families (if applicable) to coordinate care services while respecting the families right to decide the appropriate care setting for the child. ECC CM will collaborate with health care providers to develop a treatment plan that aligns the child with the appropriate care services. ECC improves communication among health care providers, member, parent/guardian, systems, and agencies. ECC CM help to reduce duplication of efforts, ease transitions of care, limit gaps between service providers, and secure transportation or other support / enabling services. Required Qualifications:  Must meet ONE of the following requirements:   Licensed Registered Nurse, (RN), in the state of Florida with no disciplinary action with a minimum of 2 years Pediatric acute care experience  Licenses Practical Nurse, (LPN), in the state of Florida without disciplinary action with a minimum of 4 years Pediatric acute care experience  Licensed Clinical Social Worker, (LCSW), with 1-year pediatric experience Must meet all of the following requirements:  Minimum 2 years complex care coordination, Enhanced Care Coordination (ECC)  Intermediate or better working knowledge of Microsoft Office applications including Word, Excel, and Outlook Additional Requirements / Adherence Workstyle: Combination remote work at home and field based Schedule: M-F 8:30 AM-5:00 PM coverage or overtime as business needs Location: Must reside in region 6 Hillsborough or Polk County Florida Travel:  This is a field-based role and requires the ability to meet with members weekly in their homes or facilities as needed to support business needs. Transportation: This role is part of Humana’s Driver safety program and therefore requires:  Possession of a valid driver's license and access to a reliable automobile  Proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits. 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. Work at Home Guidance To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:  At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested  Satellite, cellular and microwave connection can be used only if approved by leadership  Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.  Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.  Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information TB and AHCA: 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.  AHCA Fingerprint Required. Preferred Qualifications  A good understanding of AHCA regulations, NCQA and Medicaid guidelines  Managed care experience  Certified Case Manager (CCM)  Bilingual Creole or Spanish Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Job Type: Full-time Pay: $70,000.00 - $96,200.00 per year Benefits:  401(k)  401(k) matching  Dental insurance  Employee discount  Flexible spending account  Health insurance  Health savings account  Life insurance  Paid time off  Parental leave  Retirement plan  Tuition reimbursement  Vision insurance Schedule:  8 hour shift  Monday to Friday Supplemental pay types:  Bonus opportunities Application Question(s):  REQUIRED - Do you reside in Hillsborough or Polk County Florida? YES/NO Experience:  Pediatric acute care: 3 years (Required)  Pediatric RN, LPN or LCSW: 3 years (Required) Ability to Relocate:  Hillsborough County, FL: Relocate before starting work (Required) Willingness to travel:  25% (Required) Work Location: In person

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