Humana

Psychiatric RN CM

San Antonio, Texas, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess an active Registered Nurse (RN) license with the ability to be licensed in multiple states without restrictions. A minimum of 2 years of experience in an integrated care setting managing members with behavioral health needs and/or substance use, such as crisis experience, community mental health center, behavioral health inpatient, or assertive community treatment, is required. Preferred qualifications include a Bachelor's degree, RN licensure in a compact state, Psychiatric RN Certification, experience with Medicare and/or Medicare/Medicaid populations, managed care experience, and Spanish speaking skills. The role requires effective communication, interpersonal, and problem-solving skills, along with the appropriate application of clinical knowledge. Candidates must also be able to work between 8 am and 8 pm EST, 40 hours per week with 8-hour shifts, and have reliable internet service with at least 25 Mbps download and 10 Mbps upload speeds, along with a dedicated, interruption-free workspace.

Responsibilities

The Behavioral Health Care Manager will telephonically assess and evaluate members' needs and requirements to achieve and maintain optimal wellness, guiding them towards appropriate resources. This role involves managing members challenged by serious mental illness and/or substance use, supporting both their mental and physical health. The manager will employ various strategies to manage members' physical, environmental, and psychosocial health issues, identifying and resolving barriers to effective care. They will continuously monitor patient progress through assessments and evaluations to ensure desired outcomes are met, while understanding department and organizational strategies and operating objectives.

Skills

Behavioral Health
Substance Use
Crisis Experience
Registered Nurse (R.N.)
Telephonic Assessment
Care Management
Patient Assessment
Psycho-social Health

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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