Behavioral Health Utilization Management Nurse

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity

As a Behavioral Health Utilization Management Nurse, you will follow the Utilization Management process to ensure the appropriate, necessary, and cost-effective delivery of healthcare services to plan participants. You’ll review UM activities, including prospective, concurrent, and retrospective reviews, and collaborate with our internal teams and healthcare professionals to ensure the delivery of high-quality care while minimizing unnecessary healthcare expenses.

Things You’ll Do Here:

• Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request.
• Collaborate with appropriate parties to apply the correct UM, QA, and Complaints/Grievances Workflow; Disaster Plan; Consumer and Employee Safety.
• Promote quality care and cost-effective outcomes that enhance the physical, psychosocial, and vacation health of plan participants.
• Ensure compliance with regulatory standards and guidelines related to UM activities, such as those set forth by CMS, URAC, and other regulatory agencies.
• Identify and report cases of potential overutilization, underutilization, or improper utilization of healthcare services.
• Identify potential catastrophic, high-risk, and disease management cases and refer cases to the appropriate team.
• Communicate UM decisions and recommendations to healthcare providers and plan participants.
• Maintain accurate and complete records of UM activities and ensure confidentiality of sensitive information.
• Participate in ongoing UM education and training to stay up-to-date with industry developments.
• Maintain a high level of confidentiality in accordance with HIPAA.
• Maintains an active role in assuring continuity of care for all inpatients through early discharge planning.
• Identifies and communicates to the Quality Improvement Coordinator potential quality of care and patient safety issues.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Where You’ll Work

This is a remote role.

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

What You’ll Bring to the Team:

• 3+ years of clinical nursing experience with experience in the Behavioral Health space
• 3+ UM experience+
• Active, Unrestricted RN or LPN License in your state of residence.
• Ability to work in a fast-paced, detailed, deadline-driven environment.
• Ability to maintain strict confidentiality and handle sensitive information with discretion.
• Experience working independently with strong problem solving and organization skills.
• Strong aptitude for relationship building with a highly effective communication style.

A plus if you have:

• UM or Case Management Certification
• Health insurance experience