Senior Case Manager

🕒 3 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $100.000 - $130.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

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Arlo

SiteLinkedInTodas as Vagas

11 - 50 funcionários

Fundada em 2022

⚕️ Seguro de Saúde

🤝 B2B

👥 RH Tech

💰 $4.000.000 Seed Round - Arlo em 2025-03

Healthcare Insurance • B2B • HR Tech

A Arlo é uma plataforma de benefícios e plano de saúde auto-financiada para pequenas e médias empresas, que oferece um seguro de saúde transparente e focado na prevenção, com preços previsíveis, atendimento primário sem custo, atendimento de urgência virtual, suporte de concierge e um aplicativo móvel para simplificar a administração para empregadores e corretores. Disponibiliza cobertura em quase todos os estados dos EUA (exceto WA, NY, HI, DC e OK), atendendo equipes de aproximadamente 10 a 150 funcionários, e enfatiza preços claros, redução em negativas de sinistros e estabilidade nas taxas ao longo dos anos.

Descrição

• Review claims, prior auth requests, and ADT (admission/discharge/transfer) data to identify members who would benefit from case management • Conduct clinical assessments and build individualized care plans with members • Coordinate directly with PCPs, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed • Support members through complex episodes — new diagnoses, hospitalizations, transitions of care, and chronic condition management • Partner with our utilization management workflows on medical necessity questions and appropriate level of care • Help us build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well • Document thoroughly and maintain compliance with applicable regulatory and accreditation standards

🎯 Requisitos

• Active, unrestricted RN license; multi-state compact license strongly preferred • 5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning • Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation • Strong communication skills — you can hold your own with a skeptical specialist and also meet a member where they are • Self-directed; you can run your panel without someone over your shoulder • Comfort working in a fast-moving environment where processes are still being built

🏖️ Benefícios

• High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company. • Join an important mission: Your work directly influences how people access care and improves lives at scale. • Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity. • Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare. • High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.