Front End Review Utilization Management Nurse

Profile

Description

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's 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, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

Responsibilities

Primary Care Organization 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 Florida, Kentucky, Texas, Any Compact State

Role Essentials

Active RN License

Possession of or ability to obtain Compact Nursing License

A minimum of three years clinical RN experience;

Current clinical experience, managed care experience, 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

Saturday rotation required

Role Desirables

Education: BSN or bachelor's degree in a related field

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

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.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com