Clinical Care Nurse (RN)

Conviva Senior Primary Care Okeechobee, FL, US

Become a part of our caring community and help us put health first

The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes. You will support safe Transitions of Care (TOC), reduce avoidable ED utilization, and drive Medicare Advantage Stars and quality performance. The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care to improve patient outcomes.

Conviva clinic locations may be available in the following areas: Lake Okeechobee

As a Clinical Care RN, you will contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence-based interventions. You will balance direct patient education and outreach with data-driven quality improvement efforts. The Clinical Care RN aligns daily responsibilities with organizational values, integrity, respect, empathy, and commitment to health equity – to enhance patient health outcomes and satisfaction.

Role Scope

Transitions: Care transition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient, observation and emergency department patients.
Quality: Medicare Advantage Stars, HEDIS and quality performance across value-based population.
Population Health: Deliver culturally appropriate chronic disease education to activate patients are chronic disease self-management, particularly in DM, HTN, CHF and COPD.

Duties and Responsibilities:

Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.
Proactively identify recently discharged inpatient, observation and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilization and supporting patients to prevent avoidable readmissions or return visits.
Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.
Conduct post-discharge outreach to assess understanding of discharge instructions, bottles-out medication reconciliation, symptom monitoring, and follow-up appointment adherence. Identify and escalate barriers, collaborating with providers and care team to prevent readmissions and avoidable ED utilization.
Collaborate effectively with interdisciplinary teams, including providers, care assistants, center administrators, medical assistants, pharmacy, and quality improvement staff—to implement evidence-based interventions and optimize workflows.
Document all outreach efforts, clinical interactions, and outcomes accurately and in compliance with organizational and CMS regulatory standards.
Prepare, participate and discuss patients in center huddles and high-risk rounds with providers and the center-based and interdisciplinary team.
Participate in quality improvement projects, provider education sessions, team huddles to stay current with evolving clinical guidelines and organizational priorities.
Monitor progress toward Stars and Transitional Care Management goals, proactively identify barriers, and help develop innovative solutions to improve clinical performance and patient engagement.
Support clinic operations through provider collaboration, care coordination, and community education initiatives.
Coordination and facilitation of center and market-based Wellness Events-focused in-person engagement for Stars care opportunity closures.
Maintain patient confidentiality in accordance with HIPAA.
Document patient encounters accurately and timely in the indicated platform (e.g., medical record).
Follow organizational policies related to safety, infection control, and attendance.
Perform other duties as assigned.

Use your skills to make an impact

Required Qualifications:

Must meet one of the following requirements: Associate's degree in nursing (ADN) or Bachelor's degree in nursing (BSN).
Active, unrestricted RN license (state specific as applicable).
3+ years' clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.
Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (e.g., DataHub, Compass Rose, SalesForce HealthCloud – per your prior employer's population health tools), and Microsoft Office Suite.
Willing and able to complete and maintain Basic Life Support training.

Preferred Qualifications:

Knowledge of Medicare Advantage Stars, HEDIS, CAHPS, and CMS quality requirements.
Experience with Transitions of Care, hospital discharge or ER follow up programs.
Strong clinical judgment, data analysis skills, and ability to apply evidence-based practices.
Excellent communication and motivational interviewing skills to educate and empower members.
Commitment to health equity, inclusiveness, and patient-centered care.
Basic Life Support trained.

Additional Information:

Core Competencies:

Clinical quality improvement and strategic gap closure.
Transitions of Care coordination and post-discharge support.
Member and provider engagement with motivational interviewing.
Regulatory compliance and documentation accuracy.
Data interpretation and actionable reporting.
Cross-functional collaboration and teamwork.
Time management balancing administrative and outreach duties.

Values & Mission Alignment:

Demonstrate integrity, respect, and empathy in all interactions.
Uphold the mission to improve health outcomes and member satisfaction through proactive, compassionate care.
Champion continuous learning, innovation, and professional growth.

Work Information:

This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.

Workstyle: Clinic-based, in-center 5 days per week.
Location: Must reside in designated market area, in reasonable commutable distance to assigned clinic(s).
Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required.

TB Statement:

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement:

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related 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

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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 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.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.

Share this job

Related Jobs

Telemetry

Part-time

2 days ago

RN CCFSR - Telemetry

Cleveland Clinic Port St. Lucie, FL

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title RN CCFSR - Telemetry Location Port St Lucie Facility Tradition Hospital Department Nursing Administration-Weston Hospital Job Code 001313 Shift Day/Evening/Night/Weekend Schedule 7:00am-7:30pm/7:00pm-7:30am Job Summary Job Details Join the Cleveland Clinic Martin Health team down in sunny Florida, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world . Cleveland Clinic Staffing Resources (CCSR) gives you the opportunity to care for patients in various Critical Care Units. As an RN, you will deliver exceptional care throughout the patient care journey. In this role, you will interact directly with patients and their families, offering the opportunity to enhance their experience and provide healthcare education as needed. Your collaborations will include sharing patient information, coordinating treatment plans, discussing concerns and advocating for the patient's needs to achieve the best possible outcomes. Y ou will cycle between multiple locations, including Martin North, Martin South and Tradition, providing another avenue through which to thrive . A caregiver in this position works varying shifts between 7:00AM – 7:30PM or 7:00PM – 7:30AM. Floating between Martin North, Martin South and Tradition Hospitals is required , as needed. A caregiver who excels in this role will: Provide general and specialized direct and indirect patient care through the application of sound procedures and practices . Perform accurate and complete admission assessments within defined periods. Assess and document patient's pain levels utilizing appropriate protocols . Prioritize and document patient problems based on assessed needs/problems in collaboration with the patient, family and health care team. Monitor and document patient's condition and effectiveness and timeliness of care and/or interventions. Evaluate, update and revise plan of care to facilitate achievement of planned and expected outcomes. Delegate appropriate components of the nursing care plan to other members of the nursing team. Plan delivery of patient care in collaboration with other disciplines that promotes wellness and facilitates the discharge process. Minimum qualifications for the ideal future caregiver include: Completion of a recognized course of study from an accredited School of Nursing ( Diploma, ADN or BSN program) Current state licensure as Registered Nurse (RN) Basic Life Support (BLS) c ertification through the American Heart Association (AHA) or American Red Cross Advanced Cardiac Life Support (ACLS) certification through the American Heart Association (AHA) or ALS through the American Red Cross National Institutes of Health Stroke Scale (NIH) within the last year Two years of recent experience in acute care areas utilizing telemetry monitoring such as cardiac, stepdown, medical/surgical telemetry units or concentrated care units Preferred qualifications for the ideal future caregiver include: Bachelor’s of Science in Nursing (BSN) Physical Requirements: Requires full range of body motion including handling and lifting patient, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extended periods of time. Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work. Personal Protective Equipment: Follows standard precautions using personal protective equipment as required. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster . Cleveland Clinic is pleased to be an equal employment opportunity employer.

Part-time

2 days ago

RN CCFSR - Emergency Department

Cleveland Clinic Port St. Lucie, FL

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title RN CCFSR - Emergency Department Location Port St Lucie Facility Tradition Hospital Department Nursing Administration-Weston Hospital Job Code 001312 Shift Day/Evening/Night/Weekend Schedule 7:00am-7:30pm/7:00pm-7:30am Job Summary Job Details Join Cleveland Clinic Tradition Hospital’s team of caregivers that provide top-quality patient care to the Port St. Lucie area. Opening its doors in 2013 and expanding in 2017, this state-of-the-art acute care facility has 177 patient rooms and offers a wide variety of services to meet community needs. Here, you will be supported as you follow your dreams and find where you belong, here at Tradition Hospital . Cleveland Clinic Staffing Resources (CCSR) gives you the opportunity to care for patients in various Critical Care Units. As an RN, you will deliver exceptional care throughout the patient care journey. In this role, you will interact directly with patients and their families, offering the opportunity to enhance their experience and provide healthcare education as needed. You will cycle between multiple locations, including Martin North, Martin South and Tradition, providing another avenue through which to thrive . How You’ll Benefit Our caregivers continue to create the best outcomes for our patients across each of our facilities. For a full list of benefits, click here . Our Center for Workplace Violence Prevention and Caregiver Well-Being sets caregiver safety as a priority, identifying , reporting and responding to incidents and providing safety resources. A caregiver in this position works varying shifts between 7:00 AM – 7:30PM or 7:00PM – 7:30AM. Floating between Martin North, Martin South and Tradition Hospitals is required , as needed. A caregiver who excels in this role will: Provide patient care through the application of sound Nursing Practice procedures and practices. Perform accurate and complete admission assessments within defined periods. Assess and document patient's pain levels utilizing appropriate protocols . Prioritize and document patient problems based on assessed needs/problems in collaboration with the patient, family, and health care team. Establish and implement plans of care in collaboration with other disciplines that promote wellness and facilitate the discharge process. Monitor and document patient's condition and effectiveness and timeliness of care and/or interventions. Evaluate, update, and revise plan of care to facilitate achievement of planned and expected outcomes. Minimum qualifications for the ideal future caregiver include: Completion of a recognized course of study from an accredited School of Nursing (ADN or BSN program) Current state licensure as Registered Nurse (RN) Basic Life Support (BLS) , Advanced Cardiac Life Support (ACLS) or ALS and Pediatric Advanced Life Support (PALS) Certification s through the American Heart Association (AHA) or American Red Cross National Institutes of Health Stroke Scale (NIH) within the last year Two years of recent experience in Emergency Department Preferred qualifications for the ideal future caregiver include: Bachelor ’s of Science in Nursing (BSN) Physical Requirements: Requires full range of body motion including handling and lifting patient, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extended periods of time. Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work. Personal Protective Equipment: Follows Standard Precautions using personal protective equipment as required for procedures. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster . Cleveland Clinic is pleased to be an equal employment opportunity employer.

ICU

Part-time

2 days ago

RN CCFSR - Critical Care

Cleveland Clinic Port St. Lucie, FL

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title RN CCFSR - Critical Care Location Port St Lucie Facility Tradition Hospital Department Nursing Administration-Weston Hospital Job Code 001314 Shift Day/Evening/Night/Weekend Schedule 7:00am-7:30pm/7:00pm-7:30am Job Summary Job Details Join the Cleveland Clinic Martin Health team in sunny Florida where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world . Cleveland Clinic Staffing Resources (CCSR) gives you the opportunity to care for patients in various Critical Care Units. As an RN, you will deliver exceptional care throughout the patient care journey. In this role, you will interact directly with patients and their families, offering the opportunity to enhance their experience and provide healthcare education as needed. You will cycle between multiple locations, including Martin North, Martin South and Tradition, providing another avenue through which to thrive . How You’ll Benefit Our caregivers continue to create the best outcomes for our patients across each of our facilities . We’re dedicated to providing what matters most to you. Our Center for Workplace Violence Prevention and Caregiver Well-Being sets caregiver safety as a priority, identifying , reporting and responding to incidents and providing safety resources. A caregiver in this position works varying days/nights from 7:00AM – 7:30PM or 7:00PM – 7:30AM. Floating between Martin North, Martin South and Tradition Hospitals is required , as needed . A caregiver who excels in this role will: Provide patient care through the application of sound Nursing Practice procedures and practices. Perform accurate and complete admission assessments within defined periods. Assess and document patient's pain levels utilizing appropriate protocols . Prioritize and document patient problems based on assessed needs/problems in collaboration with the patient, family, and health care team. Establish and implement plans of care in collaboration with other disciplines that promote wellness and facilitate the discharge process. Monitor and document patient's condition and effectiveness and timeliness of care and/or interventions. Evaluate, update and revise plan of care to f acilitate achievement of planned and expected outcomes. Minimum qualifications for the ideal future caregiver include: Completion of a recognized course of study from an accredited School of Nursing (Diploma, ADN or BSN program) Current state licensure as Registered Nurse (RN) Basic Life Support (BLS) Certification through the American Heart Association (AHA) or American Red Cross Advanced Cardiac Life Support (ACLS) Certification through the American Heart Association (AHA) or ALS Certification through the American Red Cross National Institutes of Health Stroke Scale (NIH) completed within the last year Two years of recent experience in Critical Care Preferred qualifications for the ideal future caregiver include: Bachelor’s of Science in Nursing Physical Requirements: Requires full range of body motion, including handling and lifting patient, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extended periods of time. Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work. Personal Protective Equipment: Follows standard precautions using personal protective equipment as required. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster . Cleveland Clinic is pleased to be an equal employment opportunity employer.

Part-time

6 months ago

RN CCFSR - Emergency Department

Cleveland Clinic FL

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title RN CCFSR - Emergency Department Location Port St Lucie Facility Tradition Hospital Department Nursing Administration-Weston Hospital Job Code 001312 Shift Day/Evening/Night/Weekend Schedule 7:00am-7:30pm/7:00pm-7:30am Job Summary Job Details Join Cleveland Clinic Tradition Hospital’s team of caregivers that provide top-quality patient care to the Port St. Lucie area. Opening its doors in 2013 and expanding in 2017, this state-of-the-art acute care facility has 177 patient rooms and offers a wide variety of services to meet community needs. Here, you will be supported as you follow your dreams and find where you belong, here at Tradition Hospital. Cleveland Clinic Staffing Resources (CCSR) gives you the opportunity to care for patients in various Critical Care Units. As an RN, you will deliver exceptional care throughout the patient care journey. In this role, you will interact directly with patients and their families, offering the opportunity to enhance their experience and provide healthcare education as needed. You will cycle between multiple locations, including Martin North, Martin South and Tradition, providing another avenue through which to thrive. How You’ll Benefit Our caregivers continue to create the best outcomes for our patients across each of our facilities. For a full list of benefits, click here . Our Center for Workplace Violence Prevention and Caregiver Well-Being sets caregiver safety as a priority, identifying, reporting and responding to incidents and providing safety resources. A caregiver in this position works varying shifts between 7:00AM – 7:30PM or 7:00PM – 7:30AM. Floating between Martin North, Martin South and Tradition Hospitals is required, as needed. A caregiver who excels in this role will: Provide patient care through the application of sound Nursing Practice procedures and practices. Perform accurate and complete admission assessments within defined periods. Assess and document patient's pain levels utilizingappropriate protocols. Prioritize and document patient problems based on assessed needs/problems in collaboration with the patient, family, and health care team. Establish and implement plans of care in collaboration with other disciplines that promote wellness and facilitate the discharge process. Monitor and document patient's condition and effectiveness and timeliness of care and/or interventions. Evaluate, update, and revise plan of care to facilitate achievement of planned and expected outcomes. Minimum qualifications for the ideal future caregiver include: Completion of a recognized course of study from an accredited School of Nursing(ADN or BSN program) Current state licensure as Registered Nurse (RN) Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) or ALS and Pediatric Advanced Life Support (PALS)Certifications through the American Heart Association (AHA) or American Red Cross National Institutes of Health Stroke Scale (NIH) within the last year Two years of recent experience in Emergency Department Preferred qualifications for the ideal future caregiver include: Bachelor’sof Science in Nursing (BSN) Physical Requirements: Requires full range of body motion including handling and lifting patient, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extended periods of time. Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work. Personal Protective Equipment: Follows Standard Precautions using personal protective equipment as required for procedures. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. Please review the Equal Employment Opportunity poster . Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities

Utilization Review

Full-time

3 days ago

Utilization Management Nurse

Conviva Senior Primary Care Louisville, KY

$71,100 - $97,800 / year

Become a part of our caring community 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 Use your skills to make an impact Required Qualifications Active Unrestricted RN license Possession of or ability to obtain Compact Nursing License 3+ years of clinical RN experience; Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience 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 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 Preferred Qualifications Education: BSN or bachelor's degree in a related field Experience with Florida Medicaid Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures Compact RN License Previous experience in utilization management within Insurance industry Previous Medicare Advantage/Medicare/Medicaid Experience Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. Bilingual Additional Information 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. 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. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related 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 Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 05-05-2026 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 Humana’s Primary Care Organization, which includes 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. About CenterWell, a Humana company: CenterWell is a leading healthcare 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 healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.