$5,000 Sign-On Bonus: Subject to applicable terms and conditions.
The LTSS Bilingual Field Care Manager, Social Worker assesses and evaluates members’ needs and requirements to help them achieve and maintain optimal health, safety, independence, and quality of life. This role guides members and families in accessing resources and services appropriate to their care and well-being. The Social Work Field Care Manager applies person-centered, trauma-informed, and culturally responsive strategies to address members’ functional, behavioral, environmental, and psychosocial needs within Michigan’s Long-Term Services and Supports and Home and Community-Based Services programs. Assignments are varied and frequently require interpretation, sound professional judgment, and independent determination of the appropriate course of action. Bilingual in Arabic and/or Chaldean Neo-Aramaic
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Manage an assigned caseload and complete comprehensive assessments, applying a social work lens to functional, behavioral, environmental, caregiver, and psychosocial findings, with members in their homes or other community-based settings, as well as telephonically or virtually when appropriate.
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Conduct comprehensive InterRAI Integrated Health Care assessments to evaluate members’ functional, cognitive, behavioral, environmental, social, and psychosocial needs and support person-centered care planning and LTSS service coordination. Social worker identifies clinical findings that require RN review or intervention.
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Contribute to Nursing Facility Level of Care Determination activities within the role’s scope, collaborating with licensed nursing staff when clinical review or medical complexity assessment is required.
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Develop, implement, monitor, and modify individualized person-centered care plans in collaboration with the member, authorized representative, caregivers, providers, and other members of the Interdisciplinary Care Team.
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Serve as a primary point of contact for the Interdisciplinary Care Team and coordinate with members, care team participants, and external resources to ensure identified needs are addressed.
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Assess social determinants of health and identify barriers related to housing, food access, transportation, safety, behavioral health, caregiver support, education, finances, and access to health care and community services.
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Coordinate and facilitate access to Medicaid, Medicare, HCBS waiver, behavioral health, medical, social, housing, educational, and other community resources, regardless of funding source.
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Support members in receiving services in the least restrictive and most integrated setting appropriate to their needs, preferences, health, welfare, and independence.
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Provide ongoing monitoring, care coordination, advocacy, and follow-up to evaluate progress toward care plan goals and identify changes in condition, function, risk, caregiver capacity, or service needs.
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Apply person-centered planning, motivational interviewing, trauma-informed care, and culturally responsive engagement techniques to build rapport and support informed member choice.
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Identify and escalate urgent health, safety, abuse, neglect, exploitation, behavioral health, or service-access concerns in accordance with organizational and regulatory requirements.
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Collaborate with nursing, behavioral health, primary care, specialists, waiver service providers, community agencies, and caregivers to promote continuity of care and reduce avoidable institutionalization.
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Complete timely, accurate, and compliant documentation of assessments, care plans, contacts, interventions, referrals, authorizations, and outcomes in designated electronic systems.
Required Qualifications
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Must reside in Michigan and be able to travel throughout the assigned service area, including Wayne and/or Macomb Counties.
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Fluent in English and Arabic or Chaldean Neo-Aramaic, with the ability tospeak, read, and write each language independently and without assistance.
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Active Michigan Social Work license in good standing required (LBSW, LLMSW, or LMSW). Candidates with a limited license must demonstrate active progress toward full licensure.
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2+ years of post-degree experience in social work, behavioral health, health care, care management, or community-based services.
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1+ year of experience supporting Home and Community-Based Services (HCBS) and/or waiver programs.
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Experience conducting Long-Term Services and Supports (LTSS) assessments.
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Ability to assess functional, behavioral, environmental, and psychosocial needs to support eligibility determinations, service planning, risk identification, and care coordination.
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Knowledge of LTSS, HCBS, Medicaid requirements, person-centered planning principles, member rights, and supporting members in the least restrictive setting.
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Experience collaborating with interdisciplinary teams, health care providers, members, caregivers, and community-based organizations.
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Knowledge of community health, behavioral health, social service agencies, and local resources.
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Demonstrated ability to maintain accurate, timely, and compliant documentation in accordance with organizational, state, and federal requirements.
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Strong verbal and written communication skills with the ability to build effective relationships with members, families, caregivers, providers, and community partners.
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Proficiency using electronic medical records, care management platforms, and other health care technology applications.
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Strong computer skills, including proficiency with Microsoft Word, Outlook, Excel, and web-based applications.
Preferred Qualifications
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Experience conducting InterRAI Integrated Health Care assessments and using assessment findings to inform person-centered care planning.
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Knowledge of or experience supporting Nursing Facility Level of Care Determinations in collaboration with licensed clinical staff.
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Experience with Medicaid, Medicare, dual-eligible populations, behavioral health, chronic conditions, disability services, or complex care management.
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Previous managed care experience.
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Experience with health promotion, coaching, wellness, motivational interviewing, and trauma-informed care.
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Fluent in English and Spanish, with the ability tospeak, read, and write each language independently and without assistance.
Additional Information
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Schedule/Time Zone: Monday through Friday, 8:30 AM – 5:00 PM Eastern Time Zone
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Work Location: Michigan (Wayne and Macomb Counties)
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Work Style: Field
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Travel Requirements: 75%–90% travel within Wayne and/or Macomb Counties, Michigan
TB Statement: This patient-facing role is part of Humana’s Tuberculosis (TB) screening program. Candidates selected for this role must complete TB screening.
Driving Statement: This role is part of Humana’s Driver Safety Program and requires a valid state driver’s license and personal vehicle liability insurance. The individual must maintain coverage that meets the minimum requirements of their state of residence or $25,000 for bodily injury per person, $25,000 for bodily injury per event, and $10,000 for property damage, whichever is higher.
Eligible mileage includes:
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Travel from your home to your first work location of the day.
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Travel between client or assignment locations during the workday.
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Travel from your final work location back to your home
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
