Utilization Management Nurse

CenterWell

3d • 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
• 3+ years of clinical RN experience; 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
• Travel for offsite Orientation 2 to 8 weeks
• Travel to offsite meetings up to 6 times a year
• 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
• 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.

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.
• 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 and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

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