Become a part of our caring community and help us put health first
 

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

The Care Management Liaison (CML) will be a Humana Government Business/Humana Military associate who will support a Tidewater Market and work onsite at a Multiservice Market (eMSM) office located in Navy Medical Center Portsmouth (NMCP). The nurse will support the eMSM with the referral and authorization process.

You will provide support for other Military Treatment Facilities (MTF’s)/Facilities that make up the Tidewater Market area. The locations that you will support include:

• Fort Eustis

• Langley Air Force Base (AFB)

• US Coast Guard (Yorktown, Portsmouth, Elizabeth City)

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: You will work ONSITE 5 days a week at the Military office located at Navy Medical Center Portsmouth (NMCP) in Portsmouth, VA.

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.
 

Use your skills to make an impact
 

Required Qualifications

• Active RN (Registered Nurse) license in the state(s) in which the nurse is required to practice

• 3 or more 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)

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 or more years of prior leadership experience in a Management or Supervisor capacity

Additional Information

Work Style: Office

You must be able to work ONSITE 5 days a week at the Military office located at Navy Medical Center Portsmouth (NMCP) in Portsmouth, VA.
 

HireVue Statement:  As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
 

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 – $96,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.