Care Management Support Assistant

🔥 9 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $39k - $49.4k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review inbound referrals and correspondence for processing, fulfilment, or resolution • Screen physician orders and documentation for required medical information • Request additional information from referring entities when necessary • Verify benefits coverage and eligibility under Health Plan contracts • Match referral data against medical terms, diagnoses, and procedure codes • Follow procedures for approving requests or referring them for further review • Provide referral management education to members and providers • Communicate with patients to confirm demographics and explain requested services and care • Coordinate timely delivery of care and services with providers • Communicate referral determinations to referring entities, providers, and members • Maintain detailed documentation of patient, physician, referral source, and provider interactions • Collaborate with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care • Maintain patient information security and confidentiality • Report issues delaying service delivery to the manager • Provide excellent internal and external customer service while meeting quality standards • Work 11:00 am–7:30 pm with rotational weekends; overtime as needed

🎯 Requirements

• 1-3 years of Home Health or Infusion Pharmacy experience • Knowledge of Medicare/Medicaid and commercial insurance • Experience with medical authorizations • Excellent customer service and communication skills • Wound care/Ostomy supplies experience preferred • Microsoft Office experience with Word, Outlook, and Excel preferred • Knowledge of medical billing preferred • Passion for contributing to an organization focused on continuously improving consumer experiences • Must complete Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse • Must adhere to applicable federal/state regulations and HIPAA requirements • Knowledge of applicable CPT, HCPC, and ICD-10 codes and insurance contracts

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Comprehensive benefits package supporting employees’ and families’ health and financial well-being

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