Daily Process
This process is used to move a follow up attempt to an earlier date.
What is edit the follow up attempt?
A member is unable to provide all necessary inbound authentication elements. You should do this.
What is hang up and call the member back?
Your member rep states they have POA with Humana. ODOS is not working. You can use this platform to locate POA in many cases.
What is Service Read Only (SRO)?
These is an ideal time to read emails and/or process updates such as the weekly newsletter.
What is in the morning prior to making calls and during down time?
Your member completed a med rec 10 days ago and now is discharged again with NO medication changes (includes dose, frequency, route). You should do this.
What is document as ineligible and disposition the alert as Member not eligible?
In addition to no scheduled calls, this must also occur for a member to sweep from your roster when you are assigned user.
What is member needs attempt cycle completed?
You should do this prior to starting an assessment with an inbound call.
What is verify member state of residence?
When completing a conference call, you must do this to avoid getting another call.
What is select a not ready state?
Note: most cases will be after call work but any non-ready state will work.
Your member wants to know about copay information for a particular service. You do not locate the information in Debut or group plan grid, this would be your next step.
What is call customer service?
This is the standard follow up when a member completes or agrees to complete a med rec.
What is 1-2 business days?
This must occur to complete a do not call request.
What is add phone number to the Do Not Call Lookup directory and add appropriate hCAT actions?
A member is showing a responsible user, managed, and complex care management LOI. You should do this first.
What is check for CM availability?
Your member was readmitted before the med rec was completed. You should do this with the med rec alert.
What is nothing? HUMCS - Med Rec Alert Disposition (humana.com)
Important items for team meetings, goals, meeting guidance, timekeeping can be found here.
What is the team OneNote?
You should complete this when a member is not eligible for a med rec.
What is nurse led med review.
You are not licensed in the state the member is currently residing. You should do this.
What is ask team/leader if anyone is licensed in member's state that could manage the member?
You should only document here if there is not a two-way exchange of clinical health information.
What is document a CGX communication note only?
Your member does not have a case in CGX. You should do these two things.
What is work with member at member level in CGX if needed and notify leader to create a case.
Your time off request is approved in Verint and Workday. These are your next steps.
What is block hCAT calendar, secure VM coverage including sending invite to covering CM and leader, and place an out of office message in outlook?
You are to do this with unable to complete med rec emails.
What is upload to CGX member attachments?
Care managers must do this at the end of each day.
What is review/reconcile roster for scheduled calls, follow up attempts, actions recorded, managed status, etc?
The member has a SNP/Dual tab in hCAT and the population says SNP. You should do this.
What is refer to SNP? process coming soon
You can use this feature in CGX for continuity during your follow up call.
What is split screen in CGX?
You should do this if Verint did not send you an approved, waitlisted, or denied request.
What is verify the request is for time away not for HUMCS training event?
Med rec opportunities begin with this.
What is start a CM Post Hospitalization survey?