Clinical Nursing Manager

1 month ago


Lincoln, Nebraska, United States Humana Full time
Job Summary

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 ensuring high-quality, cost-effective, and appropriate allocation of member services, treatments, and resources.

Key Responsibilities
  • Manage and coordinate clinical nursing services to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
  • Work within specific guidelines and procedures to apply advanced technical knowledge to solve moderately complex problems.
  • Develop and monitor goals for staff, provide ongoing feedback and coaching, and 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, overseeing utilization management functions, including 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.
  • Function as a clinical resource for the multi-disciplinary care team on an ongoing basis 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.
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.



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