Job title: Utilization Management RN
Company: Devoted Health
Job description: At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!Job DescriptionA bit about this role:As a Clinical Guide, you'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services; while supporting our members through assessment, care and conservation. You'll serve as an advocate for our members, coordinating care and ensuring they have the necessary resources and support to achieve their health goals (recovering from an illness, improving quality of life, overall well-being, etc.)Our Clinical Guide is committed to integrity and excellence and empowering members to confidently navigate the healthcare system and live healthier lives. Our ideal Clinical Guide is caring, compassionate and solutions-oriented, and is enthusiastic about providing an outstanding experience for Devoted Health’s members.Required skills and experience:An unrestricted Registered Nurse (RN) license with a minimum of 4 years RN experienceAn unrestricted, Licensed Vocational Nurse (LVN) license with an advanced degree, and applicable years of experience within UMA minimum of 3 years experience doing utilization management at a health planAbility to work rotating weekendsPlease note, this role will have specific shift requirementsDesired skills and experience:Ability to work in a startup, fast paced environmentThe ability to comfortably multi- task: you’ll be listening, talking and typing all at the same timeTeam player mentality with a can-do attitudeUnderstanding of CMS guidelines and MA requirementsAdaptability and comfort in a dynamic, startup environmentTransparency in your work - what’s going well and what’s notA desire to make a change in the healthcare experience: you love to serve and make a differenceProven success in building relationshipsThe ability to adjust your tone and approach to different peopleThe ability to articulate and break down complex informationYour Responsibilities and Impact will include:Engage with members and understand their needs, using technology and data to better understand the member and any unspoken needsPerforms initial, concurrent, and discharge reviews of all cases, including: using medical guidelines to determine the medical appropriateness of inpatient and outpatient services; assessing, interpreting, and responding to the needs or requirements of patients; identifying, escalating and resolving complex cases or issues as required.Reviews current charts for appropriateness and correct admission status (inpatient, observation, bedded outpatients).Alerts and collaborates with appropriate leadership concerning patients who do not meet medical appropriateness criteria.Obtains admission and continued stay certification or recertification.Communicates with an attending physician regarding patients who do not meet criteria in order to identify additional documentation needs or potential status change.Coordinates care and discharge planning. Makes arrangements for appropriate post-hospital care, including physical and behavioral medicine, transportation, equipment, home health care, etc.Identifies, documents and communicates potential quality assurance or risk management issues as appropriate.Conduct holistic assessment to identify comorbid conditions, ED/ hospitalization history, medications, psycho-social factors, and member values and preferencesCollaborate with our PCP partnersDevelop care plans in partnership with members and their caregivers - problems, goals, interventions - continuously evaluating the member’s progressWork closely with Local Service Guides to identify community-based organizations to support the member in meeting their goalsCollaborate with members, providers, and caregivers to ensure a positive outcomeExplain complicated medical terms in plain languageEducate members on appropriate care and settings based upon their healthcare needsSupport members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decisionsPrepare members for their inpatient and outpatient treatments and coordinate post-treatment careSupport and coach members to improve management of their chronic conditions, including medication adherence and complianceSalary Range: $77,657- $103,542 / yearOur ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.Our Total Rewards package includes:Employer sponsored health, dental and vision plan with low or no premiumGenerous paid time off$100 monthly mobile or internet stipendStock options for all employeesBonus eligibility for all roles excluding Director and above; Commission eligibility for Sales rolesParental leave program401K programAnd more....*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Expected salary:
Location: USA
Job date: Thu, 29 Aug 2024 01:08:30 GMT
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About Intuitive Health Services
Intuitive Health Services is your premier partner in locum tenens healthcare staffing, with over 15 years of dedicated experience. We specialize in providing tailored staffing solutions across patient care, correctional facilities, and state hospitals, ensuring exceptional care through our meticulous matching of skilled professionals. Our extensive network spans 50+ locations, offering personalized career guidance and comprehensive support from resume assessments to interview preparation. At Intuitive Health Services, we prioritize collaborative success and community empowerment, fostering environments where healthcare professionals thrive. Join us today at 520 West Lacey Blvd, Hanford, CA 93230, or contact us at jobs@intuitivehealthservices.com / +1 (805) 703-3729 to discover how we can elevate your healthcare staffing experience.
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