CenterWell Pharmacy is seeking a Telephonic Care Manager to serve as a dedicated Autism Care Navigator. In this role, you will be the primary advocate for beneficiaries receiving care under the Autism Care Demonstration (ACD), coordinating comprehensive services for individuals with a primary diagnosis of Autism Spectrum Disorder. You will collaborate with families, providers, and military treatment facilities to ensure integrated care planning and support.
What You'll Do
- Serve as the primary advocate for the beneficiary and family, collaborating with other Care Managers to coordinate care activities.
- Conduct assessments for the development and bi-annual updates of a comprehensive care plan.
- Notify and provide the care plan to providers and parents/caregivers, ensuring all required baseline measures are completed.
- Collect and provide outcome measure data as defined by ACD policy, serving as the point of contact for MTF Care Managers.
- Perform telephonic care management for beneficiaries in the East region, focusing on coordinating services for ASD-related treatment.
- Assess beneficiary and family needs, collaborating with stakeholders to initiate treatment and address barriers.
- Determine necessary resources such as educational programs, community resources, and support groups for families.
- Participate in care management and service coordination following Medical Management policies and procedures.
- Utilize Motivational Interviewing and solution-oriented communication approaches.
- Work collaboratively with stakeholders across the Enterprise to provide consultative assistance and coordinate services.
- Develop comprehensive care plans in collaboration with identified stakeholders.
- Provide professional and courteous service to all callers, resolving complaints and issues.
- Participate in and facilitate Coordinated Team Conferences, documenting and sharing meeting summaries.
- Actively communicate with other Autism Care Navigators to ensure continuity of care during beneficiary relocations.
- Assist families in identifying local resources, including Respite care.
- Monitor ECHO registration and EFMP enrollment, ensuring required documentation is received.
- Maintain a provisional list to ensure completion of required application processes.
- Follow beneficiaries to ensure coordination and approval of services.
- Ensure data is entered accurately and monitor reports to make necessary corrections.
What We're Looking For
- You must meet one of three license/experience pathways:
- Licensed Clinical Social Worker (LCSW), LMSW-ACP, or Clinical Psychologist with clinical experience in pediatrics, behavioral health, and/or ASD; healthcare environment experience; proven care management; an active Certified Care Manager (CCM) designation or must obtain within first year; minimum of 1 year of post-degree clinical experience; minimum of 1 year of managed care experience.
- Licensed Professional Counselor (LPC), LCMFT, or LMHC with clinical experience in pediatrics, behavioral health, and/or ASD; healthcare environment experience; proven care management; an active CCM designation; minimum of 1 year of post-degree clinical experience; minimum of 1 year of managed care experience.
- Registered Nurse (R.N.) with clinical experience in pediatrics, behavioral health, and/or ASD; healthcare environment experience; proven care management; minimum of 3 years of clinical nursing experience; minimum of 1 year of managed care and case management experience; an active CCM designation or must obtain within first year.
- U.S. citizenship is required per the Department of Defense contract.
- Ability to successfully receive interim approval for a government security clearance (eQIP).
- Cannot reside in Puerto Rico per government contract.
- Proficiency in Microsoft Office programs, specifically Word, Excel, and Outlook.
- Skilled in written and verbal communications.
- Ability to handle a high volume of calls and customer contacts in a polite and professional manner.
- Ability to handle multiple projects simultaneously and prioritize appropriately.
Nice to Have
- Prior experience with the TRICARE Autism Care Demonstration.
- Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism.
- Direct or Indirect Military experience.
- Extensive analytical skills.
- Bilingual proficiency.
Technical Stack
- Microsoft Office (Word, Excel, Outlook)
Team & Environment
You will serve as a Humana Military liaison to TRICARE beneficiaries, providers, and others involved in care planning.
Benefits & Compensation
- Annual salary range: $59,300 - $80,900
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Comprehensive time off, including paid time off, company and personal holidays, volunteer time off, and paid parental and caregiver leave.
- Short-term and long-term disability insurance.
- Life insurance.
- Bonus incentive plan based upon company and/or individual performance.
Work Mode
This is a fully remote position.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
