Underwriting and Pharmacy Nurse Consultant

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.A Little More About Us: ●      We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.●      We are quickly becoming one of the fastest growing health benefits companies in the country. We have received numerous awards and accolades, including Inc. Magazine Best in Business Gold Medal award in 2021, and JMP Securities Top 50 Private Companies in Insurtech in 2022.●      Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way. A Little More About the Role:We’re looking for an experienced Registered Nurse with underwriting and pharmacy experience. You’ll take what we’re doing - creating a health plan people will love – and create a system to learn about our most complex members so we can support shared decision making with members, and guide cost-effective, optimal healthcare decisions. You’ll have a passion for creating solutions for complex member situations and the ability to help predict spend and outcomes. You’ll work directly with our Clinical Services including Pharmacy, Underwriting, Reporting, Gravie Care, Claims, and partners to understand the needs of our members to drive evidenced based and innovative solutions.
You will:●      Use your knowledge to better understand the care journeys of complex members, often piecing together a puzzle from various sources of information●      Identify opportunities for lower cost medication options including site of care and alternative benefit options●      Relay to internal teams intervention opportunities and what interventions have been done●      Using your knowledge of interventions such as chemotherapy regimens, transplant processes, pharmaceuticals, critical care stays including neonatal treatment, etc, you will guide the team on likely treatment plans and next steps●      Work with our Case Management teams to best assist these members●      Analyze between different settings for care to optimize member experience and to lower costs●      Bring together data and work directly with our Clinical Analytics and Reporting teams to give summaries of work being done and opportunities to intervene and improve●      Leverage your clinical experience, perceptive business sense, and critical thinking skills to optimize resources and create standards to guide members to cost effective outcomes●      Combine your experience of evidenced based practice with being innovative to drive new solutions for the best member experience●      Familiarity with diagnosis codes, procedure codes, and medication codes to help identify costs, gaps, and to guide the business and members to the right next action●      Document and follow procedures according to the standardized processes in place●      Demonstrate understanding of healthcare benefits and how they play a role in member behavior so you can navigate the healthcare system●      Be flexible and excited about change in a fast-paced, growing environment●      Demonstrate a strong sense of accountability for clinical program success●      Create effective relationships, listen, communicate and be a helpful team member across the organization
You bring:●      Bachelor’s degree in Nursing●      Experienced with evaluation of risk for costs and health outcomes●      Experience working on a cross-functional team with underwriting, care management, and stop loss●      Active RN license in the state hired●      At least 10 years of experience in clinical and managed care or underwriting roles.●      Exceptional verbal and written communication skills●      Demonstrated customer service, communication, and organizational skills●      Ability to work independently, prioritize effectively, and make sound decisions Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 w