Manager of Case Management and Utilization Review
About the gig
- Develop and implement clinical workflows to support a growing care management program
- With the assistance of the National Medical Director and the product team, implement methods to reduce overall medical spend and preventable events including ER visits and admissions
- Work closely with product and operations to define and standardize clinical operations processesWork with product to define implement metrics around provider cost and quality
- Monitor performance metrics such as readmission, patient experience, denials, and revenue across the company
- Ensure appropriate action is taken to address performance opportunities
- Assist providers with implementation of methods to reduce overall medical spend and preventable events including ER visits and admissions
- Provider education in quality metrics, coding and gaps in careManagement of provider quality and development of corrective action plans
About You
- RN or MS nursing degree
- At least three years of clinical experience
- Experience in utilization management
- Experience leading a care management program and team is an added benefit
- Familiarity with Medicare Advantage programs
Why you'll love working here
- We're mission-driven: we're revolutionizing the way cardiovascular care is delivered
- Up for the challenge: make a big impact by joining a fast-growing team in its early stages
- Great people: become a part of something incredible, and do it with an exceptionally talented, multidisciplinary team.
- We care about diversity: diversity allows us to build an excellent patient experience. We are an equal opportunity employer and we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
- opt into comprehensive health, dental and vision benefits
- enjoy flexible leave policies
- Distributed team and remote friendly culture
Our Values
- Be amazing at what you do, without ego.
- Take ownership and be accountable to yourself and the team.
- Move fast with our stakeholders' best interests at heart.
- Be open to a breadth of ideas, but focused on delivery.
- Measure and improve what really matters.
- Be candid and honest with people.
- Demonstrate high integrity, always.
- Help others and appreciate those who help you.
- Be a kind and decent human.
- Have fun.