Administrative Healthcare Professional

6 days ago


Raleigh, North Carolina, United States Humana Full time

Job Summary

We are seeking an experienced Administrative Healthcare Professional to join our team as a Care Management Support Specialist. In this role, you will contribute to the administration of care management and utilization management for the Humana Healthy Horizons in Virginia Medicaid market, facilitating effective communication to address customer needs.

Key Responsibilities:

  • Contribute to the administration of care management (CM) and/or utilization management (UM) for the Humana Healthy Horizons in Virginia Medicaid market.
  • Provides CM and UM support by managing shared mailboxes and entering data into work queues, mailing letters/educational material, researching unable to contact members, and completing other administrative functions as assigned.
  • Ensure the timely and correct submission of Commonwealth-required deliverables, research alternative contact information for hard-to-search members, contact members to engage them in our care management programs, and support inbound call escalations.
  • Provide non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state.
  • Interact with Service Coordinators and Field Care Managers who guide members and their families toward and facilitate interaction with resources appropriate for care and well-being.
  • Perform varied activities, including reporting data, tracking data, pulling reports, and monitoring/managing email.
  • Makes, receives, and soft transfers calls to and from members, providers, family, etc. Ensure timely communication and follow-up occurs with care management.


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