At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, and technology. We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

Job Description

As a Clinical Guide, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services while supporting our members through assessment, care and conservation. You'll serve as an advocate for our members, coordinating care and ensuring they have the necessary resources and support to achieve their health goals (recovering from an illness, improving quality of life, overall well-being, etc.) Our Clinical Guide is committed to integrity and excellence and empowering members to confidently navigate the healthcare system and live healthier lives. Our ideal Clinical Guide is caring, compassionate and solutions-oriented, and is enthusiastic about providing an outstanding experience for Devoted Health’s members.

Responsibilities will include:
Engage with members and understand their needs, using technology and data to better understand the member and any unspoken needs

Performs initial, concurrent, and discharge reviews of all cases, including: using medical guidelines to determine the medical appropriateness of inpatient and outpatient services; assessing, interpreting, and responding to the needs or requirements of patients; identifying, escalating and resolving complex cases or issues as required.

Reviews current charts for appropriateness and correct admission status (inpatient, observation, bedded outpatients).

Alerts and collaborates with appropriate leadership concerning patients who do not meet medical appropriateness criteria.

Obtains admission and continued stay certification or recertification.

Communicates with attending physician regarding patients who do not meet criteria in order to identify additional documentation needs or potential status change.

Coordinates care and discharge planning. Makes arrangements for appropriate post-hospital care, including physical and behavioral medicine, transportation, equipment, home health care, etc.

Identifies, documents and communicates potential quality assurance or risk management issues as appropriate.

Conduct holistic assessment to identify co-morbid conditions, ED/ hospitalization history, medications, psycho-social factors, and member values and preferences

Collaborate with our PCP partners

Develop care plans in partnership with members and their caregivers - problems, goals, interventions - continuously evaluating the member’s progress

Work closely with Local Service Guides to identify community-based organizations to support the member in meeting their goals

Collaborate with members, providers, and caregivers to ensure a positive outcome

Explain complicated medical terms in plain language

Educate members on appropriate care and settings based upon their healthcare needs

Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decisions

Prepare members for their inpatient and outpatient treatments and coordinate post-treatment care

Support and coach members to improve management of their chronic conditions, including medication adherence and compliance

Attributes to success:
A desire to make a change in the health care experience: you love to serve and make a difference

Proven success in building relationships

The ability to adjust your tone and approach to different people

The ability to articulate and break down complex information

Adaptability and comfort in a dynamic, startup environment

Transparency in your work - what’s going well and what’s not

Desired skills and experience:
Ability to work in a startup, fast paced environment

A unrestricted RN license

A minimum of 4 years of RN experience

A minimum of 3 years experience doing utilization management at a health plan

The ability to comfortably multi- task: you’ll be listening, talking and typing all at the same time

Team player mentality with a can-do attitude

Understanding of CMS guidelines and MA requirements

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

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