[Remote] Utilization Management Nurse - Home Solutions - Compact RN Required at Humana

Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Skills

Key technologies and capabilities for this role

Utilization ManagementTelephonic CommunicationClinical NursingCoordinationDocumentationBenefit AdministrationMedical ServicesCritical ThinkingOrganizational SkillsTime ManagementAnalytical SkillsPatient OutcomesCollaboration

Questions & Answers

Common questions about this position

Is this position remote?

Yes, this is a full-time, remote telephonic opportunity.

What are the required qualifications for this role?

Candidates need a minimum Associate Degree in nursing, an active RN license in a compact state with no disciplinary action, three or more years of progressive clinical experience including direct patient care to the geriatric population, effective telephonic and virtual communication skills, comprehensive knowledge of Microsoft Word, Outlook, and Excel, and the ability to work independently within a team.

What is the work schedule for this position?

The shift is Monday through Friday from 8:00 AM to 5:00 PM Eastern Standard Time.

What salary or compensation does this role offer?

This information is not specified in the job description.

What skills lead to success in this role?

Success requires passion for improving consumer experiences, excellent organizational and time management skills, solid analytical skills, technical savvy to navigate multiple systems, collaboration skills, strategic understanding, decision-making ability, and adherence to processes.

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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