Utilization Management Nurse- RN

COMPANY OVERVIEW 

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com. 

SUMMARY DESCRIPTION: 

Utilizes clinical skills to assess, coordinate, document and communicate all aspects of the utilization management department. 

ESSENTIAL FUNCTIONS:  

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate appropriate healthcare services/benefits. 
• Uses clinical tools and information/data review to conduct an evaluation of the members' needs and plan benefits 
• Works with discharge planners, etc to ensure safe discharge plans for members 
• Documents in our Utilization Management business application according to defined standards, processes, and workflows 
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure to render a timely and accurate coverage determination/recommendation. 
• Follows members along the continuum of care and communicates with providers and other parties to facilitate care/treatment. 
• Identifies members for referral opportunities to integrate into other programs and services. 
• Presents cases at interdisciplinary care team meetings collaborate with other key stakeholders so that the member can overcome barriers and meet goals and objectives 
• Utilizes Utilization management process in compliance with regulatory and company policies and procedures. 

•  Registered Nurse with unrestricted licensure 
• Required Qualifications-Minimum 3-5 years relevant Utilization Management xperience 
• Confidence working as an independent thinker, using tools to collaborate and connect with teams virtually 
• Analytical and problem-solving skills 
• Effective communications, organizational, and interpersonal skills 
• Ability to work independently 
• Effective computer skills including navigating multiple systems 
• Proficiency with standard corporate software applications, including Outlook, MS Word, Excel, as well as some proprietary applications 

Preferred Qualifications 

• 3 years working in a managed care setting 

Zing Health offers the following benefits:

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• 401(K) match up to 4%
• Paid-Time-Off
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.