Devoted Health·Waltham, Massachusetts
Responsible for conducting utilization reviews for inpatient, behavioral health, and post-acute services to ensure medical necessity and CMS compliance. Collaborates with Medical Directors for secondary reviews and manages authorization requests to optimize resource stewardship.
The weekly schedule choice is either Monday - Friday 10am-7pm EST OR Tuesday - Saturday 9am-6pm EST
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.
#LI-Remote #LI-DS1
Salary Range: $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. The actual base salary offered will 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 is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. 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. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
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.
Requires an unrestricted RN license with at least 4 years of clinical experience and 3 years of Utilization Management experience. Must possess strong knowledge of CMS regulations and Medicare Advantage requirements.
Market context
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