Case Management Liaison (CML)

Humana | Bethesda, MD

09/22/2022

Description

The Case Management Liaison (CML) process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Case Management Liaison (CML) will be a Humana Government Business/Humana Military associate located and working on site at one of the three Multiservice Market (eMSM) offices in the TRICARE East Region. The three eMSM locations include San Antonio, Texas; Tidewater, Virginia; and the National Capital Area in Washington, DC. The CML will support the eMSM with the referral and authorization process.

Key Accountabilities:

40% Provide support, assistance, and resolution to the eMSM for referral and authorization processing while establishing and maintaining collaborative working relationship with eMSM/MTF referral management associates

25% Understand and provide support for TRICARE benefit review, and Humana Military medical necessity review requirements

15% Identify and refer cases to appropriate Humana Military Care Management Programs and Quality Management

10% Support eMSM and Humana Military Field Operations by attending eMSM meetings as needed

10% Provide feedback to Regional Manager on issues that may require manager review, assistance and or coordination with other departments, managers or supervisors

Work Style: Hybrid Work (On-site and Remote) setting . When working onsite will work at the MTF located at 6000 MacArthur Boulevard Bethesda, MD 20816.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .

Required Qualifications
  • Associates degree in Nursing
  • Active RN (Registered Nurse) license in the state(s) in which the nurse is required to practice
  • 3 to 5+ years of varied clinical nursing experience
  • Effective relationship management skills
  • Proficient in MS Office Products (Outlook, Word, PowerPoint, Excel)
  • Good communication skills, verbal and written
  • Our Department of Defense contract requires U.S. citizenship for this position
  • Successfully receive interim approval for government security clearance (eQIP- Electronic Questionnaire for Investigation Processing)
  • 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. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire


Work at Home/Remote Requirements
  • WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  • A minimum standard speed for optimal performance of 25x10 (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


Preferred Qualifications
  • Experience working with the TRICARE population
  • 3 or more years of utilization or case management experience
  • Professional certification in utilization review, case management, or quality management
  • Experience working with health and business data and informatics
  • Experience with MCG
  • Good organizational skills
  • Bachelor's degree in Nursing (BSN)
  • 2+ years of prior leadership experience in a Management or Supervisor capacity


Additional Information

Work Style: Hybrid Work (On-site and Remote) setting . When working onsite, will work at the MTF located at 6000 MacArthur Boulevard Bethesda, MD 20816.

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

40

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October 6, 2022