Utilization review nurse [h1.location_city]

Join our compassionate team and champion health care for all!

At Conviva, a subsidiary of Humana, Inc., we recognize that health is not only about physical well-being but also about nurturing relationships, managing finances, and achieving personal goals. We are dedicated to creating an environment where our team members can thrive personally and professionally. Join us in making a significant impact in the lives of our patients and transforming the healthcare industry.

We are looking for a dedicated Registered Nurse (RN) to work collaboratively with healthcare professionals in reviewing medical care and services against established CMS Coverage Guidelines and NCQA review criteria. Be part of a team that prioritizes exceptional service!

Your Skills Will Make a Difference

Key Requirements :

Active, unrestricted RN license.

Ability to obtain a Compact Nursing License.

Minimum of three years of clinical RN experience.

Experience in clinical settings, managed care, DME, Florida Medicaid, or utilization management.

Demonstrated emotional maturity.

Able to work independently and collaboratively within a team.

Valid driver’s license and reliable transportation.

Willingness to travel for offsite orientation (2 to 8 weeks) and meetings (up to 6 times a year).

Ability to operate in multiple time zones.

Strong written and verbal communication skills.

Attention to detail and proficiency in Microsoft Office.

Capable of thriving in a fast-paced environment and forming positive relationships with all stakeholders.

Available for on-call rotations during weekends and holidays as needed.

Desirable Qualifications :

BSN or bachelor's degree in a related field.

Experience with Florida Medicaid.

Knowledge in Physical Therapy, DME, Cardiac or Orthopedic procedures.

Compact License is a plus.

Utilization management experience within the insurance industry.

Experience with Medicare Advantage, Medicare, or Medicaid is beneficial.

Current clinical experience in Hospital, SNF, LTAC, DME, or Home Health.

Bilingual candidates are encouraged to apply.

What We Offer :

Our employees enjoy a wide range of benefits, including medical, dental, and vision coverage, a 401(k) plan with company matching, tuition reimbursement, 3 weeks of paid vacation, paid holidays, and a supportive work-life balance. We prioritize growth, empower our employees, and foster a positive workplace culture.

This position is remote, with occasional travel required to Humana's offices for training and meetings. A reliable internet connection is essential for effective work-from-home participation.

Compensation :

The estimated salary for this role ranges from $71,100 to $97,800 per year, depending on location and relevant experience. This position also qualifies for a bonus incentive plan based on performance.

Application Deadline : 02-18-2026

About Conviva Senior Primary Care :

Conviva Senior Primary Care offers preventative care tailored for seniors, focusing on wellness visits, chronic condition management, and more. As part of CenterWell, we strive to address both physical and emotional needs, ensuring comprehensive care for our patients.

Equal Opportunity Employer :

Humana is committed to a diverse and inclusive workplace. We do not discriminate based on race, color, religion, gender, sexual orientation, national origin, age, disability or veteran status. We take affirmative action to employ and advance individuals with disabilities and protected veteran status. This policy applies to all employment actions.