Utilization Management RN

6 days, 13 hours ago
Full-time
Senior
Operations
WelbeHealth

WelbeHealth

WelbeHealth is a full-service healthcare company that offers personalized support to help seniors age well at home and in their community. Their Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive services at no cost, including ...

Family Services
251-1K
Founded 2015
$31M raised

Description

  • Direct day-to-day operations for the designated utilization management team.
  • Review prior-authorization requests for medical necessity and appropriateness.
  • Identify, develop, and deliver orientation and competency training for staff processing and reviewing authorizations.
  • Collaborate with internal and external providers, clinical staff, and others to resolve utilization management issues in a timely manner.
  • Guide continuous improvement of care delivery processes within Health Plan Services.
  • Support team performance and oversight in a clinical utilization management setting.

Requirements

  • Minimum of 3 years of relevant clinical nursing experience.
  • At least 2 years of supervisory experience.
  • Demonstrated aptitude to mentor and develop team members.
  • Strong preference for prior PACE experience.
  • RN licensure is implied by the title and role context.
  • Ability to work within utilization management and prior authorization processes.
  • Experience in a senior care or health plan services environment is preferred.
  • Must provide proof of COVID-19 vaccination or a vaccine declination form prior to employment.

Benefits

  • Medical, dental, and vision insurance coverage.
  • 17 days of personal time off (PTO), 12 paid holidays, and sick time.
  • 401(k) savings plan with employer match.
  • Base salary plus bonus.
  • Competitive total rewards package.
  • Advancement opportunities with a track record of internal hiring and promotion.
  • Additional benefits offered by the company.

Interested in this position?

Apply directly on the company website

Apply Now

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