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The Care Management Liaison shall have responsibility for coordinating with and bridging gaps between the market care management team and the enterprise/HIDE SNP care management team(s). The Care Management Liaison uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for Enrollees. Coordinates and communicates with stakeholders from market operations and enterprise operations including, but not limited to, Medical Directors, Quality Improvement and Population Health teams, and LTSS teams to facilitate optimal care, treatment, and quality outcomes.Position Responsibilities
- Collaborates with plan leadership on process improvements, trends analysis, and operational efficiencies.
- Reports to plan leadership on departmental performance, challenges, opportunities, risks, and recommendations for improvements/changes.
- In collaboration with market and enterprise partners, ensures compliance with the contract, CMS and Michigan Department of Health and Human Services (MDHHS) policies, procedures, and regulations.
- Collaborates with the Medical Director, Quality Improvement and Utilization Director, LTSS Director and other Clinical leaders to reduce barriers to care, decrease health disparities, support at-risk, underserved, and rural communities, and address HRSNs that impact Enrollees’ health and well-being.
- Reviews data to identify gaps in care and creates solutions to address these areas.
- Fosters positive relationships with MDHHS, local and state health agencies, subcontractors, providers, hospitals, nursing and assisted living facilities, member advocacy groups, community organizations, and other stakeholders.
- Participates in Care Management Collaborative meetings as required by MDHHS.
- Direct health plan care management and care coordination functions, including person centered planning and coordination with external entities, such as community organizations and other payers.
- Must reside in MI, IL, IN, OH, WI
Use your skills to make an impact
Required Qualifications
- Bachelor’s degree in nursing or social work or relevant field
- Unrestricted Michigan Licensed Registered Nurse (RN) or Licensed Social Worker (LSW). If not licensed, must obtain MI license 6 months from start date.
- Master’s degree or other advanced degree in nursing, social work, health services research, health policy, information technology, or relevant field.
- 5+ years of clinical experience, to include a combination of Utilization Management Case Management, and Managed Care.
- 2+ years of leadership experience.
- Knowledge of Medicare and Medicaid regulatory requirements and National Committee for Quality Assurance (NCQA) Standards.
- Intermediate to advanced computer skills and experience with Microsoft Office specifically Power Point, Word, Excel, and Outlook.
- Previous experience with electronic case notes documentation and experience with documenting in multiple computer applications/systems.
- Must reside in MI, IL, IN, OH, WI - and attend meetings in the market office for business needs.
Preferred Qualifications
- Prior experience leading integrated care team.
- Intermediate to advanced healthcare financial acumen.
- Nationally recognized Case Management certification.
Additional Information
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees 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.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Social Security Number Statement
Humana value's personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Interview Format
As part of our hiring process for this opportunity, we will be using an 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.$86,300 - $118,700 per yearThis 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
