Utilization Management Nurse

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $80k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Adhere to PACE program service authorization policies and ensure participant care and claims are reasonable, necessary, medically appropriate, and consistent with care plans and PCP coordination decisions • Conduct concurrent reviews of hospital admissions, including observation and inpatient stays • Drive timely transitions of care and retrospectively review inpatient admissions under 48 hours • Review claims submitted inconsistently with service authorization • Conduct concurrent reviews of subacute and SNF admissions and support discharge planning and transitions of care • Coordinate and review services delivered by contracted providers for consistency with authorizations, care plans, and PCP decisions • Use clinical knowledge, critical thinking, and analytical skills to advocate for quality care, improved quality of life, and reduced hospital stays when appropriate • Maintain accurate records of patient-related interactions • Lead the provider appeals process for rejected claims • Review provider network appeals and collaborate with the PACE Medical Director to issue written determinations

🎯 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 collaborate with internal and external stakeholders • Strong strategic thinking, problem-solving, and decision-making skills • Excellent communication and leadership abilities • Position is based in the United States • Must not require visa sponsorship

🏖️ Benefits

• Competitive salary and equity package • Comprehensive health, dental, and vision insurance • Collaborative, inclusive, and dynamic work environment • Opportunities for professional growth and development