Devoted Studios
Clinical Guide Part A: Utilization Management Nurse
Remote USA · Internship
Sponsorship not specified$85k-$95kDetected 11 days ago
LLMsComplianceCollaboration
About the role
- The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations.
- Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines.
- Your Responsibilities and Impact will include:
Responsibilities
- Manage authorization reopen requests as appropriate.
- Maintain accurate, defensible documentation of all determinations.
- Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm.
Skills
- Unrestricted RN license with a minimum of 4 years of clinical experience.
- Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting.
- Strong knowledge of CMS regulations and Medicare Advantage requirements.
- Experience preparing cases for Medical Director review
- Able to work in a fast paced environment that is constantly evolving.
- Experience with AI/LLM
- Certified in InterQual
Compensation
- $85,000-$95,000 / year
- The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting.
- 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.
- 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.
Benefits
- Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions.
- Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay.
- Issue NOMNC when coverage criteria are no longer met.
- Refer cases that do not meet criteria to the Medical Director for secondary review and final determination.
- 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
Equal opportunity
- Devoted is an equal opportunity employer.
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This listing is sourced directly from Devoted Studios's careers page and normalized into a canonical job model.