Utilization Management Registered Nurse

Indiana, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must reside in Indiana and be a Licensed Registered Nurse in the state of Indiana without restrictions or disciplinary actions, possessing at least 3+ years of experience in Medical Surgery, Heart, Lung, Emergency Room, or Critical Care Nursing. They should have working knowledge of MS Office, including Word, Excel, PowerPoint, and Teams, and the ability to quickly learn new systems and troubleshoot basic technical difficulties. The candidate must also be able to work independently under general instructions and with a team.

Responsibilities

The Utilization Management Nurse will utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. They will interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members, coordinating and communicating with providers, members, or other parties to facilitate optimal care. The nurse will also make decisions regarding own work methods, occasionally in ambiguous situations, and receive guidance where needed, following established guidelines and procedures.

Skills

Clinical Nursing

Medical Surgery

Heart

Lung

Emergency Room

Critical Care

MS Office

Word

Excel

PowerPoint

Teams

Technical Troubleshooting

Independent Work

Teamwork

Critical Thinking

Communication

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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