Utilization Management RN

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

• 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

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.

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.

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com