[Remote] Utilization Management Nurse at Humana

Indiana, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Licensed Registered Nurse (RN) in IN (Indiana) with no disciplinary action
3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
Previous experience in utilization management
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook, and Excel
Ability to work independently under general instructions and with a team
Ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed)
A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Responsibilities

Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations
Interpret and apply criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members
Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment
Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receive guidance where needed
Follow established guidelines/procedures
Provide high-quality care and services to members
Work independently and as part of a team to achieve organizational objectives

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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