Utilization Management Onsite Nurse

Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess an RN license without restrictions in Kentucky or a Compact state and reside within a 1-hour driving distance to CHI St. Joseph Hospital in Lexington, KY. A minimum of 2 years of clinical experience, preferably in adult/geriatric acute care, skilled, or rehabilitation settings, is required, along with comprehensive knowledge of Microsoft Word, Outlook, and Excel. The role also requires independent critical thinking skills, strong written and verbal communication abilities, a valid driver's license, dependable transportation, and the ability to work independently and as part of a team. Candidates must also meet criteria to be onsite with providers.

Responsibilities

The Utilization Management Nurse will utilize clinical nursing skills to support the coordination, documentation, and communication of medical services, discharges, and benefit administration determinations. This role involves interpreting clinical information and making independent determinations for appropriate courses of action. The nurse will travel to hospitals and providers for onsite reviews to assist members. This is a patient-facing role requiring onsite presence at CHI St. Joseph Hospital.

Skills

RN License

Clinical Nursing Skills

Medical Services Coordination

Benefit Administration

Discharge Planning

Microsoft Word

Microsoft Outlook

Microsoft Excel

Independent Work

Critical Thinking

Written Communication

Verbal Communication

Driver's License

Transportation

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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