Clinical Guide: Clinical Nurse Specialist - Remote Opportunity at Devoted Health

Transforming Healthcare with Devoted Health At Devoted Health, we're revolutionizing the way healthcare is delivered to older Americans. By combining compassion, health insurance, clinical care, service, and technology, we're creating a new kind of all-in-one healthcare company that puts the needs of our members first. As a Clinical Guide: Clinical Nurse Specialist, you'll play a vital role in our mission to provide high-quality, integrated healthcare solutions that everyone would want for someone they love. About the Role We're seeking an experienced Clinical Nurse Specialist to join our team as a Clinical Guide, working remotely. As a Clinical Guide, you'll be responsible for driving clinical excellence across multiple areas, including Utilization Management (UM) Operations, Claims, Appeals, Quality of Care Reviews, Provider Disputes, Policy Development, Compliance, and Peer-to-Peer Discussions. Under the guidance of our Senior Clinical UM Advisor, you'll work in a fast-paced, dynamic environment that requires strong clinical expertise, leadership skills, and the ability to collaborate with cross-functional teams. Key Responsibilities and Impact Develop and update UM policies, ensuring they are current and effective. Research and develop position statements on new and emerging technologies, staying ahead of the curve in healthcare innovation. Consult on and perform claims reviews, including provider dispute resolution and high-cost claim review, to ensure accurate and fair outcomes. Analyze trends in pended claims and provide actionable recommendations for improving the UM and claims processes. Prepare and advise on quality of care reviews and appeals, ensuring that our members receive the highest quality care. Analyze trends within appeals related to the UM process and provide feedback to the UM leadership team to drive continuous improvement. Educate the UM team on quality assurance and risk management issues, promoting a culture of excellence. Provide training and coaching on the use of InterQual tools to a team of UM nurses, enhancing their skills and expertise. Participate in peer-to-peer discussions, fostering collaboration and clinical decision-making. Assist in ongoing health plan accreditation preparation and compliance, ensuring that we meet the highest standards. Essential Qualifications and Skills To succeed in this role, you'll need: An unrestricted Registered Nurse license. A minimum of 4 years of experience as an RN, with at least 3 years in utilization management at a health plan. Provider clinical experience, giving you a deep understanding of the healthcare landscape. Proven leadership, agility, and collaboration skills, with the ability to work effectively in a fast-paced startup environment. A strong understanding of CMS guidelines and Medicare Advantage requirements. Certified InterQual Trainer status, demonstrating your expertise in utilization management tools. Preferred Qualifications and Skills While not essential, the following skills and experience will make you an even more competitive candidate: A client-focused mindset, with a passion for delivering exceptional service. The ability to thrive in an evolving startup environment, adapting to new challenges and opportunities. Organizational skills, with the ability to manage complexity and prioritize tasks effectively. A desire to innovate and improve processes, driving continuous improvement. Strong analytical and strategic planning skills, with a proven track record of success in a highly regulated industry. Career Growth and Learning Benefits At Devoted Health, we're committed to helping our employees grow and develop in their careers. As a Clinical Guide: Clinical Nurse Specialist, you'll have opportunities to: Develop your clinical expertise and stay up-to-date with the latest healthcare trends and innovations. Enhance your leadership and collaboration skills, working with cross-functional teams to drive clinical excellence. Participate in ongoing training and development programs, ensuring you have the skills and knowledge needed to succeed. Work Environment and Company Culture As a remote employee, you'll be part of a dynamic and distributed team that values flexibility and work-life balance. Our company culture is built on a foundation of compassion, collaboration, and innovation, with a commitment to diversity and inclusion. We believe in treating our employees like family, and we're dedicated to creating a safe and supportive work environment that allows everyone to thrive. Compensation and Benefits We offer a competitive salary range of $100,000 - $110,000 per year, along with a comprehensive total rewards package that includes: Employer-sponsored health, dental, and vision plans with low or no premium. Generous paid time off, allowing you to recharge and pursue your passions. A $100 monthly mobile or internet stipend, supporting your remote work setup. Stock options for all employees, giving you a stake in our company's success. Bonus eligibility for all roles (excluding Director and above), with commission eligibility for Sales roles. A parental leave program, supporting you and your family during life's milestones. A 401K program, helping you plan for your financial future. And more... Join Our Mission If you're a compassionate and innovative Clinical Nurse Specialist looking for a new challenge, we want to hear from you. As a Clinical Guide at Devoted Health, you'll play a critical role in our mission to transform healthcare for older Americans. Apply today and let's build the future together! Devoted Health is an equal opportunity employer, committed to a diverse and vibrant workforce. We welcome applications from candidates who share our values and are passionate about delivering exceptional healthcare experiences. Apply for this job