Utilization Management Nurse

Become a part of our caring community and help us put health first

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives.

We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well‑wellness by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

Conviva Care Solutions is seeking an RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others.

Daytona, FL;
Louisville, KY;
San Antonio, TX

Use your skills to make an impact

• Active unrestricted RN license
• Possession of or ability to obtain Compact Nursing License
• A minimum of three years clinical RN experience
• Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience
• Demonstrates emotional maturity
• Ability to work independently and within a team setting
• Valid driver’s license and/or dependable transportation necessary
• Travel for off‑site orientation 2 to 8 weeks
• Travel to off‑site meetings up to 6 times a year as requested
• Willing to work in multiple time zones
• Strong written and verbal communication skills
• Attention to detail, strong computer skills including Microsoft office products
• Ability to work in fast paced environment
• Ability to form positive working relationships with all internal and external customers
• Available for on‑call weekend/holiday rotation if needed

• Education:
  
  BSN or bachelor’s degree in a related field
• Experience with Florida Medicaid
• Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
• Compact license preferred
• Previous experience in utilization management within Insurance industry
• Previous Medicare Advantage/Medicare/Medicaid experience a plus
• Current nursing experience in Hospital, SNF, LTAC, DME or Home Health
• Bilingual

We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work‑life balance, growth, a positive and fun culture and much more.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

40

$71,100 – $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness…