The Social Worker, Social Services works in a telephonic environment, assessing and evaluating members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Social Worker, Social Services work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Social Worker, Social Services employs a variety of strategies, approaches, and techniques to manage members' physical, environmental, and psychosocial health issues. You will identify and resolve barriers that hinder effective care and ensure patients are progressing toward desired outcomes through continuous monitoring, assessments, and evaluations. You may develop and maintain member care plans to support individual healthcare needs and goals. You will understand departmental, segment, and organizational strategies and operating objectives, including their connection to related areas. You will make decisions regarding your own work methods, occasionally in ambiguous situations, while requiring minimal direction and seeking guidance when needed. You will follow established guidelines, policies, and procedures to deliver effective and compliant care management services.
Scheduled Hours
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The working hours for this position are Monday through Friday from 9:30 am – 6:00 pm EST.
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The first 2 weeks of training will be from 8:30 AM to 5:00 PM EST.
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No time off is permitted during the first month of training. The first 60 days following training are critical in building your foundation; therefore, planned or unplanned time will not be approved.
What You'll Do:
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Serve as a Licensed, Master's-level Social Worker within the Special Needs Plan (SNP) program, functioning as a Support Social Services associate and interdisciplinary care team member.
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Conduct telephonic outreach to members with social determinants of health (SDOH) needs to assess, support, and coordinate care using plan benefits and community resources.
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Utilize structured assessments to determine appropriate interventions, including care coordination, health education, resource connection, and advocacy.
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Collaborate with interdisciplinary team members (e.g., nurse care managers, dietitians, behavioral health, pharmacists), providers, and community partners to address member needs.
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Handle both outbound and inbound member interactions in a telephonic, work-from-home environment; perform follow-up as needed to ensure all needs are addressed.
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Assess members for additional support needs and initiate referrals to appropriate disciplines based on individualized circumstances.
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Develop, update, and maintain member care plans as needed to support ongoing care coordination.
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Document all interactions and care activities accurately in the member record to ensure CMS compliance and reflect engagement with members and care teams.
Required Qualifications
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Master's degree in social work from an accredited university.
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Current, unincumbered, social work license (LMSW, LCSW, or LICSW).
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Must have passed the ASWB Master's-Level exam.
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Minimum 3 years of experience working as a social worker in a medical healthcare setting (i.e. hospital setting, clinic).
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Proficient in Microsoft applications including Word, Outlook, Excel.
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Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously.
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Must be willing to obtain/maintain social work licensure in multiple states, based on business need.
Preferred Qualifications
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Experience in a telephonic environment working with geriatric, vulnerable, and/or low-income populations.
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Experience and comfort using Epic EMR.
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Experience working with Medicare and Medicaid.
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Licensure in AL, FL, GA, KY, LA, MS, NC, OK, or SC
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Bilingual English/Spanish or English/Creole
Additional Information
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Work Style: Work at Home; MUST have wired cable or DSL connection directly to a modem. At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required.
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.
$59,300 - $80,900 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.
