Registered Nurse Clinical Manager

Location

Portland, ME

This is not a remote or work-from-home position. This position requires you to sit on-site at our Portland, ME branch location.

The RN Clinical Manager manages all direct care patient services provided by clinical personnel. The role focuses on home health clinical quality assurance and home health clinical operations projects. Report to the Branch Director.

• Develop, plan, implement, analyze, and organize clinical operations for a specific location.
• Conduct or delegate the assessment and reassessment of patients, including updating care plans and interpreting patient needs, following company or physician procedures.
• Manage the assignment of caregivers.
• Oversee the delivery of care to all patients served by the location, including receiving case referrals, reviewing available patient information, determining home health or hospice needs, ensuring patients meet admission criteria, and assigning appropriate clinicians.
• Instruct and guide clinicians to promote performance and delivery of quality home care services; available during operating hours to assist clinicians.
• Assist clinicians in establishing therapeutic goals, setting priorities, and developing patient Plan of Care (POC).
• Monitor cases to ensure documentation complies with regulatory agencies and third‑party payer requirements; ensure final audits/billing are completed and comply with Medicare regulations.
• Coordinate communication among team members, attending physicians, and caregivers to ensure appropriate care and outcome planning.
• Work with the Branch Director and Finance Department to establish revenue and budget goals for the location.
• Participate in sales and marketing projects.
• Oversee all clinical employees assigned to the location; coordinate and evaluate the location; manage supervisory responsibilities per company procedures.
• Handle employee corrective action and discipline issues fairly and objectively with HR and the Executive Director/Director of Operations.
• Participate in interviewing, hiring, and developing direct care clinicians; evaluate performance relative to job goals; coach staff and recommend in‑service education; ensure adherence to internal policies.
• Assess staff education needs based on clinical documentation review and utilization review feedback; create and conduct regular staff education.
• Analyze situations, identify problems, and evaluate alternative courses of action using performance‑improvement principles.
• Lead quality assurance and performance‑improvement activities; work with utilization review staff on data tracking and analysis of care outcomes.
• Provide direct patient care infrequently and only during emergencies.
• Act as Branch Director in their absence.
• Interpret company standards and procedures to ensure compliance with external regulators and ensure caregiver documentation meets internal standards.
• Participate in performance‑improvement activities and maintain clinical knowledge through training; interpret knowledge and provide direction to staff.
• Maintain relationships with referral and community sources; participate in professional organizations and conduct care‑related programs.

• Graduate of an accredited School of Nursing.
• Current state license as a Registered Nurse.
• Proof of current CPR.
• Valid driver’s license, auto insurance, and reliable transportation.
• At least two years as an RN with one year of management experience.
• Home health experience preferred.
• Management and people‑leadership experience preferred.
• OASIS experience preferred; OASIS certification (HCS‑O, COQS, and/or COS‑C) preferred.
• Homecare Homebase (HCHB) experience preferred.
• CMS PDGM billing knowledge and/or experience preferred.

Full‑time, 40 hours per week. Normal hours:
Monday‑Friday, 8 a.m. – 5 p.m. (ET). Rotating on‑call shift.

$77,200 – $106,200 per year, based on experience and qualifications. Eligible for a bonus incentive plan.

Humana offers medical, dental, and vision benefits; 401(k); paid time off; short‑term and long‑term disability; life insurance; and other benefits. Full details available upon request.

Humana is an equal‑opportunity employer and encourages application from qualified employees regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Policies are in place to guarantee fair hiring practices and provide affirmative action in all employment decisions.