Humana · 3 months ago
RN Clinical Operations Manager, Home Health
United States
Full-time
Remote
Mid, Senior Level
$77K/yr - $106K/yr
2+ years expHumana is a leading provider of home health services, and they are seeking an RN Clinical Operations Manager to oversee direct care patient services and ensure clinical quality assurance. The role involves managing clinical operations, guiding clinicians, and coordinating communication among team members to enhance patient care and operational efficiency.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Coordinates and oversees all direct care patient services provided by clinical personnel
Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed
Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies
Manages the assignment of caregivers
Responsible for and oversees the delivery of care to all patients served by the location
Receives case referrals
Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs
Accountable to ensure patients meet admission criteria and make the decision to admit patients to service
Assigns appropriate clinicians to a case, as needed
Instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is available at all times during operating hours to assist clinicians as appropriate
Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC)
Monitors cases to ensure documentation is following compliance with regulatory agencies and requirements of third-party payers
Ensures final audits/billing are completed timely and in compliance with Medicare regulations
Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning
Works in conjunction with the Branch Director and Company Finance Department to establish location’s revenue and budget goals
Participates in sales and marketing initiatives
Supervises all clinical employees assigned to a specific location
Responsible for the overall direction, coordination, and evaluation of the location
Carries out supervisory responsibilities in accordance with Company policies and procedures
Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations
Participates in the interviewing, hiring, training, and development of direct care clinicians
Evaluates their performance relative to job goals and requirements
Coaches staff and recommends in-service education programs, when needed
Ensures adherence to internal policies and standards
Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff
Upon completion of the assessment, creates and conducts regular staff education as needed
Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles
Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements
Responsible for the QA/PI activities
Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process
Competently performs patient care assignments and staff management activities
Provides direct patient care on an infrequent basis and only in times of emergency
Acts as Branch Director in his/her absence
Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards
Qualification
Required
Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred
Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of South Carolina
Proof of current CPR card and/or BLS certification
Valid driver's license, auto insurance and reliable transportation
A minimum of 2 years of experience as a Registered Nurse (RN)
Management and people leadership experience is required
Preferred
Home health experience is preferred
OASIS experience is preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred
Homecare Homebase (HCHB) experience is preferred
Foundational knowledge and basic understanding of CMS PDGM is preferred
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-16
2026-01-16
2026-01-14
Company data provided by crunchbase