Care Guide - Physical Health

DescriptionThe Care Guide (Care Coach 1) assesses and evaluates member''s 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.ResponsibilitiesThe Care Guide (Care Coach 1) work assignments are often straightforward and of moderate complexity. Additional responsibilities for the Care Guide are further defined by these two separate roles :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.OrThe 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 coordinationThis 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. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.Position Responsibilities:The Care Guide assesses and evaluates member''s needs via telephonic and face to face assessments and evaluations, in order to coordinates services and address member short term needs:Assures completion of an HRA or other assessmentsAssists members to remediate immediate and acute gaps in care and accessAssists members with filing grievances and appealsProvides information to members related to MCO requirements, services, and benefitsProvides members with information and/or referrals to community resourcesCoordinates services, and monitoring and evaluating the care coordination plan against the member''s personal goals and identified needsGuides 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 appropriateRequired QualificationsMinimum 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.Must reside in OhioTravel within the state is expected to meet with membersExceptional interpersonal skills with the ability to quickly build rapportStrong written and verbal communication skills.Strong advocate for members at all levels of care.This role is considered member facing and is part of Humana Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.This role is 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 100/300/100 limits.Work Style: Remote work at HomeHours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.Location: Must reside in the state of Ohio - Prefer Dublin or Columbus Ohio area within a 30-45 mile radius.Travel: 5-20% travel to office for staff meetings and training. Travel within the state to meet with members. Leader will discuss during the interviewRemote Work at Home Requirements:Must have a separate room with a locked door that can be used as a home office to ensure absolute and continuous privacy during while you workMust have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)Preferred Qualifications:Bachelor''s degree in Social Work, Sociology, Psychology, Gerontology or related fieldCommunity Health Worker CertificationPrior experience with Medicaid, Medicare or dual eligible populationsExperience with health promotion, coaching and wellnessIn home assessment and care coordination experienceKnowledge of community health and social service agencies and additional community resourcesPrevious experience with electronic case note documentation and experience with documenting in multiple computer applications/systemsBilingual (Spanish, Somali or other) Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in assessed languages.Additional InformationInterview FormatAs part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may 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. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.Covid Compliance PolicyHumana 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.Medical, religious, state and remote-only work exemptions are available.Scheduled Weekly Hours40

Created: 2025-10-04