Utilization Management Nurse

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

Healthcare isnt just about health anymore. Its about caring for family, friends, finances, and personal life goals. Its 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, were 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 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

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 drivers 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 On Call weekend/holiday rotation if needed

Role Desirables

Education: BSN or bachelors 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$69,800 – $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

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.

About us

About Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humanas Primary Care Organization, which includes CenterWell Senior Primary Care, Convivas innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients well-being.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. https://www.eeoc.gov/sites/default/files/migratedfiles/employers/eeocselfprintposter.pdf

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.