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Um Nurse (Outpatient Prior Authorization)

Company

Devoted Health

Address , Remote
Employment type FULL_TIME
Salary
Expires 2023-12-08
Posted at 9 months 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 about this role:
As a Clinical Guide for Devoted, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of outpatient and inpatient 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 :
  • Performs initial prior authorization reviews of all outpatient and acute inpatient elective cases, including: using medical guidelines to determine the medical appropriateness of outpatient and inpatient services; assessing, interpreting, and responding to the needs or requirements of patients; identifying, escalating and resolving complex cases or issues as required.
  • Work closely with Local Service Guides to identify community-based organizations to support the member in meeting their goals.
  • Educate providers on utilization and medical management processes
  • Educate members on appropriate care and settings based upon their healthcare needs.
  • Alerts and collaborates with medical directors concerning patients who do not meet medical appropriateness criteria.
  • Collaborate with our PCP partners.
  • Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make informed decisions.
  • Engage with members and understand their needs, using technology and data to better understand the member and any unspoken needs.
  • Serve as a clinical resource for non-clinical team members
  • Prepare members for their outpatient and inpatient treatments and coordinate post-treatment care.
  • Conducts holistic assessment to identify comorbid conditions, ED/ hospitalization history, medications, psycho-social factors, and member values and preferences.
  • Collaborate with members, providers, provider network teams, and caregivers to ensure a positive outcome.
  • Explain complicated medical terms in plain language.
  • Support and coach members to improve management of their chronic conditions, including medication adherence and compliance
  • Identifies documents and communicates potential quality assurance or risk management issues as appropriate.
Attributes to success:
  • The ability to adjust your tone and approach to different people.
  • The ability to articulate and break down complex information.
  • Proven success in building relationships.
  • Adaptability and comfort in a dynamic, startup environmentTransparency in your work - what’s going well and what’s not
  • A desire to make a change in the healthcare experience: you love to serve and make a difference.
Desired skills and experience:
  • A minimum of 4 years of RN experience.
  • Team player mentality with a can-do attitude.
  • An unrestricted RN license.
  • Ability to work in a startup, fast paced environment.
  • Understanding of CMS guidelines and MA requirements.
  • The ability to comfortably multi- task: you’ll be listening, talking and typing all at the same time.
  • A minimum of 3 years experience doing utilization management at a health plan.
Salary Range: $80,000 - $95,000 anually
Our Total Rewards package includes:
  • Employer sponsored health, dental and vision plan with low or no premium
  • 401K program
  • Generous paid time off
  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
  • And more....
  • Parental leave program
  • Stock options for all employees
  • $100 monthly mobile or internet stipend
  • 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.