Job Description
📋 Description Review claims, prior auth requests, and ADT (admission/discharge/transfer) data to identify members who would benefit from case management Conduct clinical assessments and build individualized care plans with members Coordinate directly with PCPs, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed Support members through complex episodes — new diagnoses, hospitalizations, transitions of care, and chronic condition management Partner with our utilization management workflows on medical necessity questions and appropriate level of care Help us build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well 🎯 Requirements Active, unrestricted RN license; multi-state compact license strongly preferred 5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation Strong communication skills — you can hold your own with a skeptical specialist and also meet a member where they are Self-directed; you can run your panel without someone over your shoulder Comfort working in a fast-moving environment where processes are still being built 🎁 Benefits High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company. Join an important mission: Your work directly influences how people access care and improves lives at scale. Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity. Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare. High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.
