Utilization Management Nurse

CenterWell

19h • Remote

About The Position

Become a part of our caring community 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 Use your skills to make an impact

Requirements

• Active Unrestricted RN license
• Possession of or ability to obtain Compact Nursing License (including Nevada)
• 5+ years of clinical RN experience
• 5+ years of Acute Care experience in the hospital ICU and or ER settings
• Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience
• Ability to work independently and within a team setting
• Valid driver's license and/or dependable transportation necessary
• Ability to cross train/float among teams as needed.
• Travel for offsite Orientation 2 to 8 weeks
• Travel to offsite meetings up to 6 times a year
• Ability to work 9:00 am to 6:00 pm EST
• 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

Nice To Haves

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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level