Nurse Case Management Liaison | Humana Positions

Job’s Overview:

Humana is seeking a Nurse Case Management Liaison in Bethesda, MD. Please take a moment to read the job post below if you are interested:

R-276085

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: Must be able to work onsite 4 to 5 days a week at the Military Treatment Facility (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

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: Onsite. Must be able to work onsite 4 to 5 days a week at the Military Treatment Facility (MTF) located at 6000 MacArthur Boulevard Bethesda, MD 20816.

Scheduled Weekly Hours

40

Getting the Nurse Case Management Liaison designation comes with some responsibilities. It would be a wise idea to take a few minutes to learn more about it so you can make an informed decision.

Applicants must meet the above-mentioned requirements in order to qualify for consideration to work as a Nurse Case Management Liaison.

By clicking on the apply now button, you will be redirected to the official recruitment website where you can fill out your application.