Utilization Management RN

WelbeHealth•Los Angeles, CA

1d•$48 - $63

About The Position

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.

Requirements

Minimum of three (3) years of relevant clinical nursing experience
Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members

Nice To Haves

Strong preference for prior PACE experience
Inpatient care experience PREFERRED

Responsibilities

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

Benefits

Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
And additional benefits
WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits.

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