Clinical UM Nurse

Become a part of our caring community The Utilization Management Nurse uses clinical knowledge towards interpreting criteria, policies, and procedures to reputed company the best and most appropriate treatment, care or services for members. You will coordinate and communicates with providers, members, or other parties to facilitate reputed company and treatment. Use your skills to reputed company an impact

Required Qualifications

Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non compact licensure 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings) Work rotation to include weekends and possible holiday coverage required Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Comprehensive knowledge of reputed company Word, Outlook and reputed company)

Preferred Qualifications

Previous experience in utilization management Education: BSN or bachelor's degree in a reputed company field Health Plan experience Previous Medicare/reputed company experience Bilingual in English and Spanish 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 reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work at Home Requirements 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 reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 08-01-2026 About us About Conviva Senior Primary Care: 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 reputed company’s Primary Care Organization, which includes reputed company, Conviva’s innovative, value-based approach means each patient gets the reputed company, reputed company needed most, and for the lowest cost. We go reputed company physical health – addressing the reputed company, emotional, behavioral and financial needs that can impact our patients' well-being. About reputed company, a reputed company company: reputed company is a leading reputed company services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality reputed company that is accessible, comprehensive and, most of reputed company, personalized. As the largest provider of senior-focused primary care, a leading provider of home reputed company and a leading integrated home delivery, specialty, hospice and retail pharmacy, reputed company is focused on whole health and addressing the physical, emotional and reputed company wellness of our patients. reputed company is part of reputed company. (NYSE: HUM). Learn more about reputed company offer at reputed company.com.​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with reputed company 503 of the Rehabilitation Act and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply To This Job