Care Guide (Physical Health) – Ohio Medicaid job in Lima, OH | Humana

Clipped from:



Humana Healthy Horizons in Ohio is seeking a Care Guide/Care Guide Plus (Care Coach 1) who will assess and evaluate member’s needs and requirements to achieve and/or maintain optimal wellness state. The Care Guide serves as a single point of contact for care coordination for members who are not assigned to a Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact at the MCO for care coordination when there is Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Connects members to CCEs, the OhioRISE Plan, or MCO Care Management if the member’s needs indicate a higher level of coordination.


This position employs a variety of strategies, approaches, and techniques to manage a member’s health issues.

  • Identifies and resolves barriers that hinder effective care.
  • Ensures member is progressing towards desired outcomes by continuously monitoring care through use of assessment, data, and conversations with member/member representative.
  • Assesses and evaluates member’s needs via telephonic and face to face assessments and evaluations, to coordinate services and address member short term needs.
  • Assures completion of an HRA or other assessments.
  • Assists members to remediate immediate and acute gaps in care and access.
  • Assists members with filing grievances and appeals.
  • Provides information to members related to MCO requirements, services, and benefits.
  • Provides members with information and/or referrals to community resources.
  • Coordinates services, and monitoring and evaluating the care coordination plan against the member’s personal goals and identified needs.
  • Guides members/families towards resources appropriate for their care.
  • Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member’s care as appropriate.
  • Work assignments are often straightforward and of moderate complexity.
  • Makes decisions regarding own work approach/priorities and follows direction.
  • Understands own work area professional concepts/standards, regulations, strategies, and operating standards.
  • Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Required Qualifications

  • Must reside in Ohio.
  • Must be able to travel 50% within the state of Ohio to meet with members.
  • Minimum one (1) year of care coordination experience.
  • Minimum one year intermediate or better of working knowledge using Microsoft Office Programs specifically Teams, Excel, Powerpoint, Outlook and Word, with the ability to troubleshoot and resolve general technical difficulties.
  • Strong understanding and respect of all cultures and demographic diversity.
  • Exceptional interpersonal skills with the ability to quickly build rapport.
  • Strong written and verbal communication skills.
  • Strong advocate for members at all levels of care.
  • This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  • Must have the ability to provide a high speed DSL or cable modem for a home office.
  • A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications:

  • Bachelor’s degree in Social Work, Sociology, Psychology, Gerontology or related field.
  • Community Health Worker Certification.
  • Prior experience with Medicaid, Medicare or dual eligible populations.
  • Experience with health promotion, coaching and wellness.
  • In home assessment and care coordination experience.
  • Knowledge of community health and social service agencies and additional community resources.
  • Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems.
  • Bilingual (Spanish, Somali or other) Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in assessed languages.

Additional Information

  • Work Style: Remote with travel to see members (see below for Travel information).
  • Workdays/Hours: Monday – Friday; 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.
  • Travel: 50% travel within state to meet members and to Humana Healthy Horizons office location in Dublin, OH for staff meetings and training. Leader will discuss during the interview.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours