Conviva Senior Primary Care
Utilization Management Nurse
Company Description
Every day at Conviva, we inspire each senior to live their best life by practicing wellness, prevention, and holistic care. In short, we believe in helping our patients age well, no matter their stage of life. Conviva’s physician-led Care Teams are driven by the passionate belief that patient care always comes first.
Job Description
The Utilization Management Nurse uses clinical nursing skills to support the coordination, documentation and communication of medical services and benefit administration determinations.
Requirements
Required Qualifications: Active and unrestricted Registered Nurse license (RN) in the (appropriate state) with no disciplinary action 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience Previous experience in utilization management Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Comprehensive knowledge of Microsoft Word, Outlook and Excel Preferred Qualifications: BSN or Bachelor's degree in a related field Health Plan experience Previous Medicare/Medicaid Experience Call center or triage experience Bilingual in English and Spanish with the ability to read/write/speak in both languages Work environment: This is a remote position. Additional Information 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 connection is suggested. Satellite, cellular and microwave connection 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. Humana 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 Humana's offices for training or meetings may be required.
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Responsibilities
The Utilization Management Nurse uses clinical knowledge, towards interpreting criteria and procedures to provide the best treatment, care or services for members. You will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will report to a Utilization RN Manager.
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