Acute Utilization Management RN - Acute Care
Company: Humana Inc
Location: San Antonio
Posted on: November 19, 2023
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Job Description:
Acute Utilization Management RNDescription
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
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
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 weekend/holiday rotation if needed
Current clinical experience is 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
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
Keywords: Humana Inc, San Antonio , Acute Utilization Management RN - Acute Care, Executive , San Antonio, Texas
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