Utilization Management Registered Nurse

At Twin Health, we empower people to reverse, prevent and improve chronic metabolic diseases. Twin Health invented The Whole Body Digital Twin™ , a dynamic representation of each individual’s unique metabolism, built from thousands of data points collected daily via non-invasive sensors and self-reported preferences. The Whole Body Digital Twin delivers a new standard of care, empowering physicians and patients to make personalized data-driven decisions.

Working here

Our team is passionate, talented, and driven by our purpose to improve the health and happiness of our members. Our culture empowers each Twin to do what’s needed to create value for our customers and our company, and enjoy their experience at work. Twin Health was awarded Innovator of the Year by Employer Health Innovation Roundtable (EHIR) (out of 358 companies), named to the 2021 CB Insights Digital Health 150, and recognized by Built In’s 2022 Best Places To Work Awards. In October 2021, Twin Health announced its Series C funding round of $155M, led by ICONIQ Growth, enabling us to scale services in the U.S. and globally, helping to solve the global chronic metabolic disease health crisis. We have recently announced broad and growing partnerships with premier employers, such as Blackstone and Berkshire Hathaway. We are building the company you always wished you worked for. Join us in revolutionizing healthcare and building the most impactful digital health company in the world!

Excited to join us and do your part in improving people’s health and happiness?

Opportunity

This is an exciting role for a UM Registered Nurse with a diverse healthcare systems background and experience in Utilization Management. Join us to use your finely-tuned clinical skills in the design and deployment of an UM service line. Your role ensures that Twin Health’s health care services are administered with quality, cost efficiency, and within compliance. To be successful in this role, you also need to work efficiently and with competing priorities, you are comfortable with technology and data, and are able to employ knowledge of care management principles.

Responsibilities

• Support the design and deployment of cross functional UM processes
• Perform frequent case reviews, check medical records, speak with patients and Twin UM physician regarding adherence to Twin treatment plan
• Completes audits of members who have achieved medication elimination to avoid leakage based on external prescribing
• Work closely with Finance Team to provide documentation to ensure accuracy in Twin’s billing for medication milestones
• Support Step Therapy, a program that requires patients to try a lower cost drug before “stepping up” to more a more expense drug, by working closely with the Step Therapy team to incorporate UM best practices into their processes
• Maintain accurate records of all patient and provider related interactions generated in support of medication elimination adherence
• Support the update of member reporting to provide updates to leadership team
• Evaluates member progress toward goal achievement, including identification and evaluation of barriers to meeting or maintaining plan of care and/or health status
• Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members
• Engages the nursing philosophy to capture a holistic picture of the member’s clinical status from Intake to ongoing care management
• Gives appropriate health guidance by utilizing clinical knowledge, training and protocols
• Strictly adheres to Standard Operating Procedures for member management and escalations
• Provides timely responses and feedback to colleagues regarding member care
• Conducts detailed monitoring to support medication reconciliation and adherence
• Collaborate with members and pharmacies to identify solutions to defray costs for members and reduce gaps in coverage
• Organizes accurate records and maintains confidentiality according to federal law and Twin policies
• Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concerns
• Contributes to the development and improvement of clinical care that enhances cost effectiveness while ensuring quality care
• Participates in on-going education and performance improvement activities
• This role will report to a nurse manager and work cross functional with UM physician and Clinical Delivery contact.

Qualifications

• Currently active and unencumbered Compact RN license
• Minimum 2 years of nursing experience in various healthcare systems such as hospitals, Federally Qualified Health Care centers, ambulatory care environments (primary care, internal medicine, family practice, surgical/multi-specialty), health payor systems, Pharmacy, etc.
• Experience preferred in Utilization Management (2 to 3 years)
• Comfortable working with data/analytics and generating performance improvement reports
• Required, BSN or MSN from accredited school of nursing
• Comfort and enthusiasm for adopting the latest technologies and integrating data and technical outputs in patient care
• Demonstrated ability to manage large caseloads and effectively work in a fast paced environment
• Proficient with simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.)
• Comfort with ambiguity and change, experience in a high-growth, or other quickly changing environment
• Professional telephone and video skills
• Self-motivated and results-focused
• Quick learner who integrates new knowledge
• Organized and detail-oriented
• Ability to handle competing demands with diplomacy and enthusiasm
• Ability to work collaboratively with clinical infrastructure and hierarchies
• Excellent time management and ability to prioritize work assignments
• Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases
• Bilingual, fluent in Spanish preferred
• This remote opportunity is available to US based persons.

Compensation and Benefits

The compensation range for this position is $80,000-$80,000 annually.

In addition, Twin has an ambitious vision to empower people to live healthier and happier lives, and to achieve this purpose, we need the very best people to enhance our cutting-edge technology and medical science, deliver the best possible care, and turn our passion into value for our members, partners and investors. We are committed to delivering an outstanding culture and experience for every Twin employee through a company based on the values of passion, talent, and trust. We offer comprehensive benefits and perks in line with these principles, as well as a high level of flexibility for every Twin

• A competitive compensation package in line with leading technology companies
• As a remote friendly company we are committed to providing opportunities for all who join to further build relationships, increase cross-functional collaboration, and celebrate our accomplishments.
• Opportunity for equity participation
• Unlimited vacation with manager approval
• 16 weeks of 100% paid parental leave for delivering parents; 8 weeks of 100% paid parental leave for non-delivering parents
• 100% Employer sponsored healthcare, dental, and vision for you, and 80% coverage for your family; Health Savings Account and Flexible Spending Account options
• 401k retirement savings plan