Utilization Management Nurse Team Lead

Health One AllianceDalton, Georgia

Apply with Sonara

Automate your job search with Sonara.

Submit 10x as many applications with less effort than one manual application.¹

Reclaim your time by letting our AI handle the grunt work of job searching.

We continuously scan millions of openings to find your top matches.

Overview

Schedule

Full-time

Education

Nursing (RN, LPN)

Career level

Director

Remote

On-site

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Job Description

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSEThe UM Nurse Team Lead ensures efficient, cost effective, and high quality delivery of utilization review service by supporting and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.

ESSENTIAL JOB DUTIES

Serve as a clinical and operational team lead for Utilization Management nurses, providing day to day guidance, mentorship, and clinical supportAct as an escalation resource for complex utilization reviews, appeals, and provider/member issues requiring advanced clinical judgment

Trains and develops utilization review staffWorks with Utilization Management Manager to establish and ensure achievement of completion of prior authorization reviews, productivity, and quality goals

Initiate referrals to ensure appropriate coordination of careSeek the advice of the Medical Director when appropriate, according to policy

Assists non-clinical staff in performance of administrative reviewsPerforming comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility

Maintains regular and predictable attendanceConsistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice

Works to encourage and promote Company culture throughout the organizationOther duties as may be assignedQUALIFICATIONS

3 years Clinical experience preferred2 years of Utilization Review

Proficient in Microsoft Office (Outlook, Word, Excel)Working knowledge of NCQA preferred

Must be able to work in an independent and creative mannerAbility to manage multiple projects and priorities

Adaptive to high pace and changing environmentCustomer service oriented

Proficient in interpreting benefits, contract language and medical policy/medical review criteriaCurrent, active Compact State license in Nursing (RN)

PHYSICAL REQUIREMENTSProlonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

• BENEFITS• 401K (4% Match, Immediate Vesting) • Accident insurance• Competitive salary• Critical Illness Insurance• Dental Insurance• Employee Assistance Program• Flexible Spending Account• Health & Wellness Program• Health Savings Account• Life & AD&D Insurance• Long Term Disability• Medical Insurance• Paid Time Off• Pet Insurance• Short Term Disability• Vision Insurance

PRE-EMPLOYMENT SCREENINGDrug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYERAll qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

Automate your job search with Sonara.

Submit 10x as many applications with less effort than one manual application.

Apply with Sonara Apply manually

FAQs About Utilization Management Nurse Team Lead Jobs at Health One Alliance

What is the work location for this position at Health One Alliance?

This job at Health One Alliance is located in Dalton, Georgia, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.

What pay range can candidates expect for this role at Health One Alliance?

Employer has not shared pay details for this role.

What employment applies to this position at Health One Alliance?

Health One Alliance lists this role as a Full-time position.

What experience level is required for this role at Health One Alliance?

Health One Alliance is looking for a candidate with "Director" experience level.

What education level is required for this job?

The education requirement for this position is Nursing (RN, LPN). Candidates with relevant qualifications or equivalent experience may also be considered.

What benefits are offered by Health One Alliance for this role?

Health One Alliance offers following benefits: Health Insurance, Dental Insurance, Vision Insurance, Disability Insurance, Life Insurance, Paid Vacation, 401k Matching/Retirement Savings, and Health & Wellness Programs for this position. Actual benefits may vary depending on the employer's policies and employment terms.

What is the process to apply for this position at Health One Alliance?

You can apply for this role at Health One Alliance either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.