Utilization Management RN

WelbeHealth; Los Angeles (CA); On-site; USD 99,000 - 131,000; Full time

Benefits offered by this job

Medical insurance (Medical, Dental, VY

401K savings + match

PTO - 17 days

12 holidays observed annually

Advancement opportunities

Job summary

WelbeHealth, LLC. is seeking an Utilization Management RN Supervisor in Los Angeles to lead the UM team and drive efficient care delivery. You will supervise daily operations, review medical necessity authorizations, and mentor staff while collaborating with internal and external providers.

The role offers a comprehensive benefits package and a base salary with bonus potential, reflecting experience and qualifications. Vaccination policy applies to all employees.

Qualifications

• Minimum of three (3) years of relevant clinical nursing experience.
• Two (2) years of supervisory experience with aptitude to mentor staff.
• Strong preference for prior PACE experience (if stated).

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, clinical staff, and others to timely resolve utilization management issues.

Skills

Nursing experience

Supervisory experience

Utilization Management

Staff coaching

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.

• 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

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

$99,309.58 - $131,088.64 USD

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Applicants must be legally authorized to work in the United States without current or future employer sponsorship. At this time, WelbeHealth does not provide any employment-based visa sponsorship, including H-1B, TN, E-3, O-1, F-1 OPT/STEM OPT, or other employment-based work authorization.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in WelbeHealth’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.