Humana Case Manager Jobs in Texas (NOW HIRING)

General Summary: The Hospital Case Manager Assistant (HCMA) supports the Hospital Case Management (HCM) Nurses in various tasks, including monitoring patients on the hospital census, scheduling patient appointments for hospital follow-ups and the High-Risk Team, and facilitating the coordination of authorized Referral Services.

Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements: All duties performed will be done accurately and in a timely manner.

1. Develop and maintain supportive, productive, and effective relationships with external and internal partners.
2. Ensures customer service is always maintained at the highest level.
3. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
4. Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
5. Bilingual English/ Spanish fluency preferred.
6. Maintains strictest member and company confidentiality.
7. Must have excellent written and verbal communication skills.
8. Strong attention to detail and exceptional organizational skills.

Essential Job Responsibilities:         

1. Composes an accurate daily Hospital Census capturing all Humana, Wellpoint and SCAN patients in the hospital, SNF and inpatient rehabilitation facilities.
2. Distributes census per protocol to appropriate delegated staff.
3. Verify insurance eligibility and benefits from HMO eligibility lists or by contacting insurance companies by phone when needed.
4. Assists Hospital case managers in obtaining authorization from the health plan.
5. Prints inpatient authorization/denial letters and mails to the patients and faxes them to providers/facilities.
6. Communicates patient concerns promptly to the Case Manager nurses for attention and follow-up.
7. Schedules patients to the High-Risk Team of providers for appropriate visit / care as requested by the HCM.
8. Enter timely and accurate information into the EMR to document pertinent patient/family communications, referral authorizations and plans.
9. Assists with computer data entry.
10. Demonstrate excellent customer service: Assist patients and staff to set up services or resolve concerns.
11. Document appropriately in GMG computer systems, and other associated systems.
12. Assists with producing letters, faxing documents and mail outs (certified and other).
13. Maintain current knowledge of health plan benefits, health plan contracts and preferred provider network.

Education and Training: Minimum high school education or equivalent required.

 Experience: Experience in a clinic, doctor’s office or hospital with a minimum of one-year experience preferred.

 Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: Office environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position.  Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor.  Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.

Education and Training: Minimum high school education or equivalent required.

 Experience: Experience in a clinic, doctor’s office or hospital with a minimum of one-year experience preferred.

 Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: Office environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position.  Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor.  Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.