REMOTE POST ACUTE RN REVIEW NURSE, KY

Conviva

Apply Now

We are creating a LinkedIn guide for Nurses. To make it as useful as possible, we need your help.

 

If you can take 3 minutes to fill out a short survey, we will be very grateful. 🙏

 

👉  Survey

Location: KY
Location Type: Remote
Schedule: Full_time
Req: R-328785

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

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

 

The Utilization Management Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

  • Bachelor’s degree, preferred
  • Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action – compact state preferred, with ability to obtain noncompact state license.
  • 3 – 5 years Clinical Nursing experience required
  • Previous experience in utilization management preferred.
  • Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  • Comprehensive knowledge of Microsoft Word, Outlook and Excel
  • Ability to work independently under general instructions and with a team
  • Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Compact Nursing Licensure
  • Must rotate to Saturday coverage, maybe required to rotate holiday
  • Strong computer skills and attention to detai

Preferred Qualifications

  • Education: BSN or Bachelor’s degree in a related field
  • Health Plan experience
  • Previous Medicare/Medicaid Experience a plus
  • Bilingual is a plus

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

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 Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s 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 because he or she is a protected veteran. 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.