Utilization Management Registered Nurse

Twin Health 

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 hosp