Clinical Nursing Manager
2 weeks ago
We are seeking a highly skilled Clinical Nursing Manager to join our team at Humana. As a key member of our healthcare operations team, you will be responsible for overseeing the coordination, documentation, and communication of medical services and benefit administration for post-acute determinations.
Key Responsibilities- Manage the utilization management process, ensuring high-quality, cost-effective, and appropriate allocation of member services, treatments, and resources.
- Provide oversight, education, support, and coaching to ensure associates' performance meets expectations and regional operational goals/metrics.
- Develop and monitor goals for staff, provide ongoing feedback and coaching, conduct annual performance reviews, and lead by example.
- Support the daily management and operations of the department, overseeing utilization management functions, including timely authorizations, pre-certification, concurrent review, referrals, and other plan services.
- Implement and execute policies and processes necessary to support the business need and maintain compliance with regulatory requirements.
- Analyze operational and analytical reports to monitor and track operational efficiency.
- Perform case reviews, properly document utilization management activities, and rationale for all decisions in electronic medical records systems.
- Function as a clinical resource for the multi-disciplinary care team to maximize the quality of patient care while achieving effective medical cost management.
- Provide support and staffing on weekends and holidays as needed.
- Licensed Registered Nurse (RN) in IL, WI, MN, SD, ND, IA, NE, KS, MO, or a compact license, with no disciplinary action.
- Utilization Management experience is required for this role.
- Post-acute experience as it relates to skilled nursing home, rehab, and/or LTAC is required for this role.
- 2+ years management or leadership experience in a clinical setting.
- Strong attention to detail, excellent time management, and organizational skills.
- Excellent communication skills, both verbal and written.
- Proficient with Microsoft Word, Outlook, and Excel.
- Ability to work independently under general instructions and with a team.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
- Bachelor's degree in nursing (BSN).
- MCG Milliman experience.
- Health Plan experience.
- Previous Medicare experience a plus.
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
- Satellite, cellular, and microwave connection can be used only if approved by leadership.
- 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.
- Humana will provide Home or Hybrid Home/Office associates 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.
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.
Equal Opportunity Employer
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