[Remote] Utilization Management - Behavioral Health at Humana

Kentucky, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor’s degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky
Licensed Masters Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC), Psychologist (PhD), or Registered Nurse (RN) or other professional license
Three (3) or more years of post-degree clinical experience in private practice or other healthcare settings
Intermediate working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word
Exceptional oral and written, communication, and interpersonal skills
Must reside in the state of Kentucky or a county that is contiguous to Kentucky state border in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia

Responsibilities

Supports the coordination, documentation, and communication of medical services and/or benefit administration determinations
Interprets criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction
Follows established guidelines/procedures

Skills

Utilization Management

Behavioral Health

Clinical Knowledge

Communication Skills

Critical Thinking

Coordination of Care

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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