[Remote] Utilization Management 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

Associate’s Degree or higher
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
Compact (multistate) RN license
3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and within a team
Understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas
Ability to self-direct, take initiative and meet deadlines
Desire to embrace continuous learning in an agile work environment
Strong attention to detail to ensure requirements are met and guidelines followed
Passionate about contributing to an organization focused on continuously improving consumer experiences

Responsibilities

Support the coordination, documentation, and communication of medical services for members
Interpret 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
Work independently and collaboratively
Maintain a dedicated workspace lacking ongoing interruptions to protect member PHI / HIPAA information
May be required to travel to Humana's offices for training or meetings

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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