Clinical Nursing Manager

3 weeks ago

Lincoln, Nebraska, United States Humana Full time
Job Summary

Become a part of our caring community and help us put health first. As a Clinical Nursing Manager, you will utilize your clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.

Key Responsibilities
  • Work within specific guidelines and procedures to apply advanced technical knowledge to solve moderately complex problems.
  • Receive assignments in the form of objectives and determine approach, resources, schedules, and goals.
  • Ensure 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; lead by example; and ensure an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions.
  • Support the daily management and operations of the department. Oversees utilization management functions which include timely authorizations related to 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.
  • Ability to perform case reviews. Properly documents utilization management activities and rationale for all decisions in electronic medical records systems.
  • Functions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management.
Requirements
  • 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.
  • 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.
Preferred Qualifications
  • Bachelor's degree in nursing (BSN).
  • MCG Milliman experience.
  • Health Plan experience.
  • Previous Medicare experience a plus.
Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable, or DSL connection is suggested.
  • 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.
About Humana

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 veteran status. 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.

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