Join us in transforming healthcare. 

At Longevity Health, we’re dedicated to advancing healthcare through innovation, compassion, and excellence. We’re looking for passionate individuals to join our team and help us make a difference. The individual holding this position is required to support and demonstrate their commitment to Longevity Health’s purpose: To optimize the quality of life of people in long-term care by focusing on their individualized health needs.

Key Tasks and Responsibilities:

• Team Leadership:
  • Lead a team of utilization management nurses, providing guidance, coaching, and performance management.
  • Foster a collaborative team environment that supports continuous improvement and professional development.
  • Coordinate team activities to ensure timely and accurate processing of utilization review requests and ensure workload distribution is balanced.
• Utilization Management Oversight:
  • Conduct clinical reviews for medical necessity and appropriateness of care according to established criteria and guidelines.
  • Ensure reviews are completed in a timely manner, with a focus on quality and compliance with organizational, legal, and regulatory standards.
  • Collaborate with physicians, healthcare providers, and insurance companies to discuss and clarify medical treatment plans, as necessary.
  • Implement and monitor clinical criteria and processes to ensure efficient utilization of resources while maintaining high-quality patient care.
  • Review denials and appeals to ensure consistency and appropriateness of decisions, providing support for clinical staff as needed.
• Quality Assurance & Compliance:
  • Ensure that utilization management processes and decisions are in compliance with regulatory requirements and internal policies.
  • Participate in audits and assessments to ensure the accuracy and effectiveness of the team’s work.
  • Review and interpret utilization data to identify trends and opportunities for improvement in patient care and resource use.
• Interdepartmental Collaboration:
  • Collaborate with care coordination and clinical teams to ensure a coordinated approach to patient care.
• Training & Development:
  • Develop and implement training programs for new hires and ongoing education for existing team members.
  • Stay updated with current clinical guidelines, utilization management tools, and industry trends to ensure the team’s knowledge is current and comprehensive.

Supervisory Responsibilities:

• No supervisory direct reporting employee

Credentials & Coverage:

• Registered Nurse (RN) with an active, unrestricted nursing license.
• Auto insurance coverage as required by your state of residence. New employees will be responsible for providing proof of coverage prior to hire and on an ongoing basis.

Education and Training:

• Registered Nurse (RN) with an active, unrestricted nursing license.
• Bachelor’s Degree in Nursing (BSN) preferred.

Knowledge and Experience:

• Minimum of 5 years of clinical nursing experience, with at least 2 years in utilization management or related field.
• Previous leadership or supervisory experience in a clinical setting preferred.
• Effective verbal and written communication skills required.
• Effective organizational skills.
• Advanced computer skills- MS Office Products required.
• Emotional intelligence, calm when under pressure.
• Ability to succeed in a rapidly evolving organization.
• Strong interpersonal and team skills.