RN Case Management Process Advisor

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Description

The RN Case Management Process Advisor also known as a Case Management Liaison (CML) will oversee the processing of referrals from Military Treatment Facilities (MTFs) and civilian providers. The RN Case Management Process Advisor will work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Nurse Case Management Process Advisor will be a Humana Government Business/Humana Military associate located at and working on site at the Walter Reed Multiservice Market (eMSM) office in Bethesda, MD . The nurse will support the eMSM with the referral and authorization process.

You will also provide remote/virtual support to two other Multiservice Market (eMSM) offices in the TRICARE East Region. The two eMSM locations that you will support remote/virtually include:


Portsmouth Naval Medical Center Portsmouth, Virginia for the Tidewater area
San Antonio, Texas


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


Minimum of a Associates degree in Nursing (ASN)
Active RN (Registered Nurse) license in the state(s) in which the nurse is required to practice
3 to 5 plus 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)
According to Humana's COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.


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 .

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 **** 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

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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