Utilization Management RN

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve.

Our Health Plan Services team plays a critical role in our participant’s journey and our Utilization Management team ensures we can provide timely, quality, compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of our care delivery processes.

Essential Job Duties:

• Direct oversight of day-to-day operations within the designated UM team
• Assist the team in reviewing prior-authorization requests for medical necessity and appropriateness
• Identify, develop, and provide orientation and competency development for staff processing and/or reviewing authorizations
• Collaborate with providers (internal and external), clinical staff, and others to timely resolve any utilization management issues

Job Requirements:

• Minimum of three (3) years of relevant clinical nursing experience
• Strong preference for prior PACE experience
• Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members

Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
• 401K savings + match
• Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path!
• And additional benefits