Lead Utilization Management Nurse, Inpatient

🕒 May 28

🏄 California – Remote

🏄 California – Remote

💵 $85.7k - $128.5k / year

⏰ Full Time

🟠 Senior

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

👥 B2C

💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11

Healthcare Insurance • B2C

Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.

📋 Description

• Reviews reporting to assign tasks to UM Nurses for completion of time-sensitive items. • Works closely as a liaison between management and the team to ensure timely processing of new cases. • Participates in department quality audits and vendor audits to assess timeliness of cases. • Effectively communicates with the Utilization Management leadership team regarding operations. • Assists with team coverage plans and operational support when needed. • Collaborates with leaders to develop and improve processes and workflows. • Acts as a resource to the team, members, providers, and community partners. • Leads onboarding and training of new hires, including mentoring and coaching UM Nurses.

🎯 Requirements

• Minimum of (3) consecutive years of related experience in concurrent review and/or prior authorization at managed care organization. • Minimum (2) years of experience using MCG • Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements. • Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program. • Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact).

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements