Remote Utilization Management Nurse, Tampa FL

Conviva

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Location: Tampa, FL
Location Type: Remote
Schedule: Full_time
Req: R-328573

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

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

               

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.

 

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 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 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 bachelor’s 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

Working hours: Monday to Friday 8AM-5PM

 

*** PLEASE SUBMIT A RESUME WITH APPLICAITON ***

Use your skills to make an impact

Additional Information

This role is considered patient facing and is part of Humana/Senior Bridge’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

 

Alert

Conviva, a subsidiary of Humana, values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

 

Interview Format: MODERN HIRE

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

 

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

 

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

 

#LI-JM3

 

 

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.