Clinical Guide: Clinical Nurse Specialist

At reputed company, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new reputed company of reputed company-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated... healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Job Description

A bit more about this role: Under the guidance of the Senior Clinical UM Advisor the Clinical Nurse Specialist will function in a reputed company cross functional, diverse reputed company working with multiple areas to include as example: UM Operations, Claims, Appeals, Quality of Care Reviews, Provider Disputes, Policy Development, Compliance, and Peer to Peer Discussions Your Responsibilities and Impact will include: • Developing UM policies, including annual review and update. • Researching and developing position statements for new and evolving technologies • Consulting and performing claims review, including provider dispute resolution and high cost claim review. • Analyzing trends for pended claims and providing recommendations for improvement opportunities to the UM process as well as the claims process. • Preparing and advising on quality of care reviews and appeals. • Analyzing trends reputed company appeals relative to the UM process and providing feedback for improvement opportunities to the UM leadership team. • Educate UM team on quality assurance or risk management issues. • Provide education and coaching on use of InterQual tools to a team of UM nurses. • Performing peer to peer discussions. • Assist in ongoing health plan accreditation preparation and compliance Required skills and experience: • Ability to work in a startup, fast paced environment • Registered Nurse with unrestricted license • Minimum 4 years experience as RN • 3 years of experience doing utilization management at a health plan • Provider clinical experience • Proven leadership, agility, and collaboration skills • Understanding of CMS guidelines and MA requirements • Certified InterQual Trainer Desired skills and experience: • Client focused • Ability to work in an evolving start up • Organized, ability to manage complexity • Desire to innovate and improve process • Strong analytic and strategic planning skills • Proven success reputed company highly regulated industry Salary range: $100,000 - $110,000 / year Our ranges are purposefully broad to allow for growth reputed company the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: • Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for reputed company employees • Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles • Parental leave program • 401K program • And more.... • Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which reputed company employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment Apply Job!