Care Management Liaison Nurse

The Care Management Liaison (CML) Nurse will oversee the processing of referrals from Military Treatment Facilities (MTFs) and civilian providers. The CML will work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Care Management Liaison (CML) registered nurse (R.N.) will be a Humana Government Business/Humana Military associate will support a Multiservice Market (eMSM) office in Central Texas. The nurse will support the eMSM with the referral and authorization process.

You will provide remote/virtual support for three Military Treatment Facilities (MTF’s) that make up the Multiservice Market (eMSM) office in the Central Texas Plan area. The locations that you will support include:

• Fort Sam Houston
• Randolph AFB
• Lackland Air Force Base (AFB)

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: For the first 30-60 days in the position, you must be able to work ONSITE 4 to 5 days a week at the Military office located at 7800 interstate 10 West, San Antonio, TX 78230. After the training period you will work remote.

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

• 3 to 5 plus years of varied clinical nursing experience
• Good communication skills, verbal and written
• Proficient in MS Office Products (Outlook, Word, PowerPoint, Excel)
• Our Department of Defense contract requires U.S. citizenship for this position
• Minimum of an Associate’s degree in Nursing (ASN)
• Successfully receive interim approval for government security clearance (eQIP- Electronic Questionnaire for Investigation Processing)
• Active RN (Registered Nurse) license in the state of Texas
• Effective relationship management skills

Work at Home/Remote Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense

Preferred Qualifications

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

Additional Information

Work Style: Hybrid (Remote/Onsite) in the State of Texas

For the first 30-60 days in the position, you must be able to work ONSITE 4 to 5 days a week at the Military office located at 7800 interstate 10 West, San Antonio, TX 78230

ALERT: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.
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.
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Scheduled Weekly Hours

40