[Remote] UM Behavioral Health Nurse at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Licensed Registered Nurse (RN) Compact license, with no disciplinary action
3 or more years of clinical experience
Proficient in Microsoft applications including Word, Outlook, Excel
Adept experience working with computers and comfortable learning new programs
Self-provided internet service meeting minimum speeds (25 Mbps download, 10 Mbps upload recommended; wireless, wired cable or DSL suggested; satellite, cellular, microwave only if approved)
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

Complete medical record reviews from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information
Assess discharge plans
Review and extract information from claims
Complete documentation for Quality Reviews for Peer Reviews
Discuss cases with Medical Directors
Work in partnership with other members of the Humana Interdisciplinary team
Comply with performance and reporting standards as defined by Humana
Complete additional responsibilities as deemed appropriate by Humana leadership

Skills

Key technologies and capabilities for this role

Registered Nurse (RN)Utilization ManagementBehavioral HealthMedical Record ReviewMicrosoft WordMicrosoft ExcelMicrosoft OutlookMCGInterQualClaims ReviewPeer ReviewDischarge Planning

Questions & Answers

Common questions about this position

What are the required qualifications for the Utilization Management Behavioral Health Nurse role?

Candidates must be a Licensed Registered Nurse (RN) with a Compact license and no disciplinary action, have 3 or more years of clinical experience, and be proficient in Microsoft applications including Word, Outlook, and Excel.

Is this a remote position, and what are the work-at-home requirements?

This is a work-at-home or hybrid home/office role with specific internet speed requirements: at minimum 25 Mbps download and 10 Mbps upload, using wired cable or DSL preferred. A dedicated workspace without interruptions is required to protect PHI/HIPAA information, and telephone equipment is provided by Humana.

What are the working hours for this position?

The department operates Monday through Friday from 7:00 AM to 6:30 PM CST, with hours for this role based on business needs within that timeframe.

What preferred qualifications would make me a stronger candidate?

Preferred qualifications include a Bachelor’s degree in nursing (BSN), experience in Behavioral Health, Utilization Management, acute care settings, MCG or InterQual, managed care with insurance companies, EMR systems, additional non-compact licenses, and bilingual skills.

What is the salary or compensation for this role?

This information is not specified in the job description.

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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