Concurrent Utilization Management RN

Florida, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor of Science in Nursing (BSN) and hold an active RN license in Florida, with no disciplinary actions. A minimum of three years of clinical nursing experience as an RN is required, along with comprehensive knowledge of Microsoft Word, Outlook, and Excel. Previous experience in utilization management, Medicare, Medicaid, and/or Health Plan experience are preferred qualifications. The role requires residence in Florida and the ability to work remotely with a reliable internet connection meeting specific speed requirements.

Responsibilities

The Concurrent Utilization Management Nurse will continuously monitor members during hospital stays to support effective care coordination and timely discharge. This role involves applying clinical expertise, strong communication, and critical thinking to interpret criteria and policies, ensuring members receive appropriate care during transitions. Responsibilities include coordinating with healthcare providers, members, and other parties to facilitate optimal care plans, authorizing necessary post-hospital services, and exercising independent judgment in daily work.

Skills

Registered Nurse (RN)

BSN

Clinical Expertise

Care Coordination

Discharge Planning

Communication

Critical Thinking

Independent Decision Making

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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