[Remote] NICU Care Manager, Telephonic Nurse at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Registered Nurse (RN) with 3 years or more of NICU level 3 experience
Active Compact RN license with the ability to apply for additional licensure without restrictions if needed
Ability to work independently under general instructions and with a team
Team player
Strong organizational skills and experience multi-tasking

Responsibilities

Assess and evaluate members' needs and requirements to achieve and/or maintain optimal wellness state
Guide members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
Collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria
Identify and utilize appropriate healthcare resources most consistent with the member’s needs and by providing guidance along the healthcare continuum
Perform clinical case review on members during an inpatient hospital admission
Collaborate with other health care providers in reviewing actual and proposed medical care and services
Assess care needs, assist in coordinating interventions and services to meet those needs, and communicating with providers and Humana associates to promote efficient use of the healthcare system
Provide authorizations for inpatient stay
Provide care coordination and discharge planning
Provide home health and medical equipment coordination
Partner with facilities to support superior care
Work on call for rotating holidays and weekends

Skills

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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