Utilization Management Nurse
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 reputed company an impact
Required Qualifications
- 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 reputed company 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 reputed company office products
- Ability to work in fast paced environment
- Ability to form positive working relationships with reputed company internal and external customers
- Available for On Call weekend/holiday rotation if needed
Preferred Qualifications
- Education: BSN or bachelor's degree in a reputed company field
- Experience with Florida Medicaid
- Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
- Compact RN License
- Previous experience in utilization management reputed company Insurance industry
- Previous Medicare Advantage/Medicare/Medicaid Experience
- reputed company nursing experience in Hospital, SNF, LTAC, DME or Home Health.
- Bilingual
Additional Information
We offer reputed company 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 reputed company is suggested.
Satellite, cellular and microwave reputed company 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.
reputed company 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 reputed company's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$71,100 - $97,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) 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 reputed company of work. Among our benefits, reputed company 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.Application Deadline: 04-14-2026About us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of reputed company’s Primary Care Organization, which includes reputed company, Conviva’s innovative, value-based approach means each patient gets the reputed company, reputed company 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 reputed company, a reputed company company: reputed company is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of reputed company, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, reputed company is focused on whole health and addressing the physical, emotional and social wellness of our patients. reputed company is part of reputed company Inc. (NYSE: HUM). Learn more about reputed company offer at reputed company.com. Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company 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 reputed company levels of employment.
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