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Clinical Resource Management Nurse
2 months ago
Join Our Compassionate Team
At Humana, we prioritize health and well-being. As a Clinical Resource Management Nurse, you will leverage your nursing expertise to enhance the coordination, documentation, and communication of medical services and benefit administration decisions.
Role Overview
The Clinical Resource Management Nurse's responsibilities are diverse and often require independent judgment and interpretation of the best courses of action.
Key Responsibilities:
- Utilize clinical knowledge and communication skills to assess criteria, policies, and procedures for optimal treatment and care.
- Collaborate with healthcare providers, members, and other stakeholders to ensure effective care delivery.
- Understand and align with departmental and organizational strategies and objectives.
Daily Tasks:
- Update and reconcile case information as necessary.
- Evaluate clinical data for new admissions and make utilization decisions in line with established policies.
- Communicate case updates to healthcare facilities as required.
- Facilitate discharge planning and care transitions by engaging with members and their healthcare teams to maximize available resources.
Qualifications:
- Active Registered Nurse (RN) license with no disciplinary actions.
- Minimum of 3 years of acute care clinical experience.
- Proficient in Microsoft Office Suite.
- Ability to work autonomously and collaboratively within a team environment.
Preferred Qualifications:
- Bachelor’s degree in Nursing (BSN).
- Experience in utilization management or related fields.
- Familiarity with health plans and Medicare processes is advantageous.
Work Environment:
This position is remote, allowing you to work from home while ensuring a dedicated workspace that maintains confidentiality and compliance with HIPAA regulations.
Compensation and Benefits:
Humana offers a competitive salary range and a comprehensive benefits package designed to support your overall well-being, including medical, dental, and vision coverage, retirement plans, and paid time off.
About Humana:
Humana Inc. is dedicated to prioritizing health for our members and employees. Through our various services, we strive to facilitate better health outcomes for individuals and communities.
Equal Opportunity Employer:
Humana is committed to creating a diverse environment and is proud to be an equal opportunity employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.
