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Manager, Utilization Management Rn

Company

Devoted Health

Address , Remote
Employment type FULL_TIME
Salary $112,100 - $135,200 a year
Expires 2023-07-11
Posted at 1 year ago
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!
A bit more about this role:
As UM Manager, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for managing a team who is 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.
Responsibilities will include:
  • Daily monitoring of data integrity for all cases to ensure accuracy of data reporting directly to CMS, for CMS Audit Universe and Star ratings; and other internal and external reporting
  • Develop care plan in partnership with the member and their caregivers - problems, goals, interventions - continuously evaluating the member’s progress in meeting their goals
  • Educate the member on appropriate care and settings based upon their healthcare needs
  • Engage with members and understand their needs - use technology and data to better understand the member and any unspoken needs
  • Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decision about their care needs
  • Support and coach members to improve management of their chronic condition, including medication adherence and compliance
  • Develop, review, revise and monitor policies and procedures to ensure that all the work of the Clinical Team meets all regulatory requirements and standards. Compare and contract existing procedures against new regulatory requirements to effect changes timely and accurately. Ensure all regulatory,operational and documentation standards and reporting needs are met when integrating new utilization and care management programs
  • Collaborate with members, providers, and caregivers to ensure a positive outcome
  • Explain complicated medical terms in plain language
  • Prepare members for their inpatient and outpatient treatments and coordinate any care needed post-treatment
  • Apply knowledge to suggest safe exercise routines, dietary plans, meditation or stress reduction techniques
  • Conduct holistic assessment to identify co-morbid conditions, ED/hospitalization history, medications, psychosocial factors, and values and preferences
  • Provide leadership and oversight to the day to day operations of the Clinical Team including but not limited to:
  • Work closely with Local Service Guides to identify community-based organizations able to support the member in meeting their goals
Attributes to success:
  • You’ve had proven success in building relationships
  • A deep caring to make a change in the health care experience: you love to serve and make a difference
  • You can articulate and break down complex information
  • The ability to work in a startup environment: which means being transparent in your work, what’s going well, what’s not
  • Being adaptable to change as we look to make things better for your experience as a Clinical Guide and for our members - we will change things as we go and grow!
  • Being present and timely - for your team, for our members
  • Being able to balance building a relationship with our members and supporting the business
  • The ability to adjust your tone and approach to different people
Desired skills and experience:
  • The ability to comfortably multi- task: you’ll be listening, talking and typing all at the same time
  • A minimum of 5 years experience as a manager of >=10 direct reports
  • Understanding of CMS guidelines and MA requirements
  • Ability to work in a startup, fast paced environment
  • Team player mentality with a can-do attitude
  • A minimum of 5 years experience doing utilization management at a health plan
  • A unrestricted RN license
  • A minimum of 5 years of RN experience
Salary Range: $112,100 - $135,200 annually
Our Total Rewards package includes:
  • Stock options for all employees
  • 401K program
  • $100 monthly mobile or internet stipend
  • Bonus or commission eligibility for all roles
  • Parental leave program
  • Generous paid time off
  • And more....
  • Employer sponsored health, dental and vision plan with low or no premium
  • Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
The salary and/or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).
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.