Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included.

The UM Integration Nurse will work as part of the Care and Case Management team, focusing on projects and work that integrate Utilization Management (UM) with Care and Case Management (CCM). This role is ideal for a nurse who can effectively bridge these two critical areas.

Responsibilities

• Communicate and coordinate with facilities when a member is discharging to a lower level of care. 
• Perform benefit verification and pre-determination benefit decisions based on member plan documents.
• Conduct care coordination calls with our UM vendor partner to support identifying and solutioning for barriers to discharge.
• Work on transplant coordination with Center of Excellence (COE) vendors and clients.
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
• Partner with the members' local providers to ensure coordinated care.
• Coordinate with internal and external resources to support the development and execution of the utilization management program.
• Establish and maintain communication and relationships with key cross-functional stakeholders.
• Serve as an escalation point for workflow questions/clarifications and complex cases.
• Assist the clinical team with day-to-day work and direct patient care, when needed.
• Display focus towards continuous improvement, suggest alternative solutions, as well as new ideas that improve team productivity, workflows, member experience, and efficiency, aligning directly with company values and goals.
• Comfort with telephonic and video visits
• Responsibilities may shift over time depending on CCM and/or UM program needs. Other duties as assigned.

Basic Qualifications

• Bachelor of Science in Nursing (BSN) 
• Must reside in a compact NLC state.
• Active Compact RN license in good standing with the nursing board of their state.
• 5+ years of experience in nursing 
• 2+ years working in Utilization Management (UM)
• Case management experience preferred.
• Complex discharge planning experience preferred.
• Willingness to become (and maintain) licensure in multiple states.
• Skilled in using multiple technology platforms and reporting systems for data analysis, performance tracking, and report creation.
• Demonstrate strong organizational skills and comfort in reading and interpreting plan documents.
• Excellent organizational skills and attention to detail required.
• Ability to be agile and balance multiple priorities while maintaining a positive and professional attitude.
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal, and nonverbal.
• Strong ambition and internal drive are essential to this position.
• Comfortable discussing different medical conditions.
• Experience with technology and an understanding of digital tools and EMR platforms.
• Strong empathy and commitment to patient-centered care.
• Flexibility and comfort in an evolving environment.
• Strictly follow security and HIPAA regulations to protect patient medical information.
• Be pleasant, responsive, and willing to work with and learn from the team.
• Collaborate well across diverse teams with clinical and non-clinical members to deliver a seamless, top-quality care experience to patients.
• Translate medical information into clear, accessible, and patient-friendly language.
• Strict adherence to security and HIPAA regulations.

Physical Requirements

• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner.
• This position requires frequent communication with patients and physicians; must be able to exchange accurate information during these patient encounters
• Occasional overnight business travel


The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. FInally, this job description is not intended in any way to create a contract of employment.

$73,700 - $103,180 a year

The United States base salary range for this full-time position is $73,700 - $103,180 a year + equity + benefits .

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Included Health reserves the right to modify these ranges in the future. For further information, please ask your Recruiter. 

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following: 

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents 

Generous Paid Time Off ("PTO") and Discretionary Time Off (“DTO")

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment) 

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work 

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at .