Job Description

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. 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.
• Use your skills to make an impact.

Required Qualifications

• Bachelor’s degree in nursing or social work.
• Unrestricted Michigan Licensed Registered Nurse (RN) or Licensed Social Worker (LSW).
• 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 PowerPoint, Word, Excel, and Outlook.
• Experience with electronic case notes documentation and experience with documenting in multiple computer applications/systems.
• Must reside in or be willing to relocate to Michigan.
• Must be willing to attend meetings in the market office for business needs.

Preferred Qualifications

• Master’s degree or other advanced degree in nursing, social work, health services research, health policy, information technology, or other relevant field.
• Prior experience leading integrated care teams.
• 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