Conviva Senior Primary Care

Utilization Management Nurse

Posted on

December 28, 2025

Job Type

Full-Time

Role Type

Utilization Review

License

RN

State License

Compact / Multi-State

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Company Description

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 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.

Job 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. 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

Requirements

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

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