Acute Utilization Management RN

Profile

Description

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-being 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.

Responsibilities

Conviva Care Solutions is seeking a 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.

Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX

Role Essentials


Active 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 offsite Orientation 2 to 8 weeks
Travel to offsite 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 weekend/holiday rotation if needed


Current clinical experience is required

Role Desirables


Education: BSN or bachelor's degree in a related field
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.

Scheduled Weekly Hours

40

Company info

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