Utilization Management RN

Job description

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: Benefits of Working at WelbeHealth: Apply your clinical expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the...