Clinical Guide: Clinical Nurse Specialist

Remote, USA Full-time Posted 2025-03-16

At Devoted Health, 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 kind of all-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 very cross functional, diverse capacity 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 within 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 within highly regulated industry

Salary range: $100,000 - $110,000 / year

Our ranges are purposefully broad to allow for growth within 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 base 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 all employees
? Bonus eligibility for all 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 all 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 origin, 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!

Similar Remote Jobs

Clinical Guide: Clinical Nurse Specialist

Posted on: 30-09-2024 00:00

Commercial Disputes - Senior Associate

Posted on: 30-09-2024 00:00

Cable Installer ($20 PH starting)

Posted on: 30-09-2024 00:00

Principal Product Manager (Remote Eligible)

Posted on: 30-09-2024 00:00

Property Lawyer - Part-time/flexible working

Posted on: 30-09-2024 00:00

Prior Authorization Nurse Associate LPN/LVN

Posted on: 30-09-2024 00:00

Prior Authorization Nurse Associate LPN/LVN

Posted on: 30-09-2024 00:00

Customer Sales and Service Representative

Posted on: 30-09-2024 00:00

Technical Support Engineer (Night Shift)

Posted on: 30-09-2024 00:00

Entry Level Software Engineer (UK)

Posted on: 30-09-2024 00:00

Virtual Receptionist

Posted on: 16-07-2024 18:50

Property Claims Associate Trainee | Remote

Posted on: 02-08-2024 17:49

Are you looking for a flexible work-from-home opportunity? Join our team as a Home-Based Data Entry Specialist! This entry-level position is perfect for individuals who are organized, detail-oriented, and eager to contribute to a growing company?all from the comfort of your home. Responsibilities: Input and update data into company systems with high accuracy. Review and verify data for completeness and consistency. Organize and maintain digital records and files. Collaborate with team members to ensure deadlines are met. Perform quality control checks to ensure data integrity. Qualifications: High school diploma or equivalent (required); additional education is a plus. Strong typing skills (minimum 40 WPM) with attention to detail. Familiarity with Microsoft Office Suite (Excel, Word) and basic computer literacy. Ability to manage time effectively and meet deadlines. A reliable internet connection and personal computer. What We Offer: Competitive hourly pay with opportunities for bonuses. Flexible work hours?choose when you work. Comprehensive training and ongoing support. Opportunities for growth within the company. Work-life balance in a supportive remote work environment. Who Should Apply: This role is ideal for students, stay-at-home parents, or anyone looking to enter the workforce or make a career change. No prior experience? No problem?we provide training for the right candidates! How to Apply: Submit your application, including your resume and a brief cover letter, to [Email Address]. Applications are reviewed on a rolling basis, so apply early! Start your remote career with us today and make an impact?right from home!

Posted on: 23-01-2025 00:00

Sr. QA Analyst (Manual Tester), Locals only

Posted on: 30-12-2024 06:51

Inside Sales Representative - Remote

Posted on: 24-01-2025 04:50

Workday & HR Systems Senior Engineer (REMOTE)

Posted on: 22-10-2024 05:26