Contract Utilization Management Nurse

Job not on LinkedIn

🔥 45 minutes ago

🇺🇸 United States – Remote

💵 $42 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🛒 Procurement

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Intus Care

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

📣 Marketing

📦 Logistics

💰 $13.1M Venture Round on 2023-01

Consulting • Marketing • Logistics

Intus Care is a healthcare analytics platform that synthesizes healthcare data to identify risks, visualize trends, and optimize care. The company empowers long-term care providers to deliver more effective care to older adults by predicting high-risk patients, reducing expenditures through early risk detection, and improving organizational performance using data-driven insights. Intus Care is particularly beneficial for PACE (Programs of All-Inclusive Care for the Elderly) organizations, providing tools that enable care providers and executives to make informed decisions and proactively manage patient care based on real-time analytics.

📋 Description

• Rigorous adherence to PACE program service authorization policies, ensuring that participant care and related claims are: • Reasonable and necessary for diagnosis or treatment and consistent with PCP coordination decisions. • Active involvement in various aspects of the utilization management process, including: • Concurrent review of all hospital admissions (observation and inpatient) with the Interdisciplinary Team driving efficient and timely transitions of care. • Coordination and review of all other services delivered by contracted providers and identified by the PACE program assuring consistency with Interdisciplinary Team service authorization, care plans, and PCP coordination decisions. • Employ effective use of knowledge, critical thinking, and skills to: • Advocate quality care and enhanced quality of life • Maintain accurate records of all patient related interactions • Comprehensive review of provider network appeals.

🎯 Requirements

• 3 to 5 years of utilization management experience. • Current RN license • Proven experience working in risk based integrated models of care. • Ability to use data to drive decisions and collaboration with internal and external stakeholders. • Strong strategic thinking, problem solving, and decision making skills. • Excellent communication and leadership abilities, capable of motivating and guiding teams toward timely and efficient care management strategies

🏖️ Benefits

• A chance to be a part of a trailblazing team in healthcare technology. • A collaborative, inclusive, and dynamic work environment.