Included Health is a modern healthcare provider offering integrated virtual care and support services. Our mission is to improve healthcare quality for everyone by removing barriers and ensuring access to exceptional care—regardless of where individuals are in their health journey or the type of care they need, whether it’s acute, chronic, behavioral, or physical. We provide members with personalized care navigation, advocacy, and both virtual and in-person access to everyday, urgent, primary, behavioral, and specialty care. Everything is included.

The Utilization Management (UM) Integration Nurse is part of the Care and Case Management team, focusing on aligning UM processes with Care and Case Management (CCM) initiatives. This position is ideal for a nurse who can effectively connect these two essential functions.

Responsibilities:

– Coordinate with facilities during patient transitions to lower levels of care.
– Verify benefits and make pre-determination decisions based on plan documents.
– Participate in care coordination calls with UM partners to address discharge challenges.
– Support transplant coordination with Centers of Excellence and clients.
– Assist members in navigating complex medical conditions, treatment options, and the healthcare system.
– Collaborate with local providers to ensure seamless care.
– Work with internal and external teams to implement UM programs.
– Build and maintain relationships with key stakeholders.
– Act as a point of contact for workflow questions and complex cases.
– Support the clinical team with daily tasks and patient care as needed.
– Promote continuous improvement by suggesting new ideas and solutions to enhance team performance and member experience.
– Comfortable conducting phone and video consultations.
– Responsibilities may evolve based on program needs.

Basic Qualifications:

– Bachelor of Science in Nursing (BSN)
– Must live in a compact Nursing Licensure Compact (NLC) state
– Active and unrestricted Compact RN license
– At least 5 years of nursing experience
– Minimum of 2 years in Utilization Management
– Preferred experience in case management and complex discharge planning
– Willingness to obtain and maintain licensure in multiple states
– Proficient with various technology platforms and data systems
– Strong organizational skills and ability to interpret plan documents
– Detail-oriented with excellent time management
– Ability to manage multiple priorities with professionalism
– Effective communication skills across all formats
– Self-motivated and driven
– Comfortable discussing a wide range of medical conditions
– Familiarity with digital tools and electronic medical records
– Empathetic and committed to patient-centered care
– Adaptable in a dynamic work environment
– Compliant with HIPAA and data security standards
– Team-oriented and open to learning
– Able to collaborate across clinical and non-clinical teams
– Capable of translating complex medical information into clear, patient-friendly language

Physical Requirements:

– Consistent and punctual attendance
– Ability to remain seated for long periods
– Manual dexterity for operating office equipment
– Occasional lifting up to 20 lbs.
– Professional interaction with colleagues and patients
– Frequent communication with patients and healthcare providers
– Occasional overnight travel may be required

Note: Job responsibilities may change over time based on business needs. This description is not a contract of employment and may be updated as necessary.

Compensation:

Annual base salary range: $73,700 – $103,180, plus equity and benefits. Final salary will be based on factors such as education, experience, skills, certifications, and location. Included Health may adjust this range in the future.

Additional Benefits:

– Remote-first work environment
– 401(k) plan via Fidelity
– Comprehensive medical, dental, and vision insurance
– Free access to Included Health services for employees and dependents
– Generous PTO and discretionary time off
– 12 weeks of fully paid parental leave
– Family building benefits, including up to $25,000 for surrogacy and adoption
– Paid compassionate leave for pregnancy loss or fertility-related events
– 11 paid holidays, plus one floating holiday
– Work-from-home reimbursement
– 24 hours of paid volunteer time annually

About Included Health:

Included Health is redefining healthcare by offering integrated virtual care and navigation services. We aim to elevate healthcare standards for all by removing barriers and ensuring access to high-quality care—whether it’s for acute, chronic, behavioral, or physical needs. Our members receive personalized guidance and access to both virtual and in-person care across a wide range of services. Learn more at includedhealth.com.

Included Health is an Equal Opportunity Employer and welcomes applicants regardless of race, color, religion, gender, sexual orientation, national origin, age, disability, genetics, or any other protected status. We comply with the San Francisco Fair Chance Ordinance.