[Remote] UM Behavioral Health 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

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
Bachelor’s degree in nursing (BSN) (preferred)
Behavioral Health and/or Utilization Management experience (preferred)
Acute care clinical setting experience (preferred)
MCG or InterQual experience (preferred)
Managed care experience working directly with insurance companies (preferred)
Use of EMR systems (preferred)
Additional non-compact nursing licenses (preferred)
Bilingual (plus)

Responsibilities

Complete medical record reviews
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

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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