Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the health care system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Job Summary:

This position of Team Lead aids in supervising the nurses to ensure Curana Health is delivering high quality and cost- effective utilization management and case management services. They ensure that our members are getting the right healthcare at the right place and in the most cost-effective manner. The team leads assist in implementation of Curana’s clinical philosophy, programs, policies and procedures and be able to communicate the strategic plan to the staff that work with Curana’s members. Focuses on key priorities and best practices and provides innovations to improve outcomes.

Essential Duties and Responsibilities:

• Day to day supervision of staff assignments, authorization timeliness, and staff schedules.
• Maintain a current caseload of incoming authorization requests for review.
• Quality monitoring focusing on medical necessity guidelines and discharge planning opportunities to lower levels of care
• Manages adherence to policies and procedures
• Communication and education of expected outcomes and requirements
• Performance counseling of nursing staff for utilization management activities
• Assessment of developmental needs of the staff and action items to improve performance
• Ability to focus on interventions for improvement
• Monitors member and provider letters including denial, and case management correspondence
• Provides appropriate responses to clients and account managers regarding UM questions
• Maintains working knowledge and communication of legislature, insurance changes, CMS and State regulations that may affect utilization management policy, trends and standards
• Coordinates an interdisciplinary approach to support continuity of care
• Ability to implement written policies and procedures and workflows, and assist in staff education regarding policies and procedures
• Attend plan meetings, staff meetings and other meetings as assigned.

Education and Experience:

• Minimum 5 years clinical experience as RN required, including medical surgical experience
• Minimum 1-2 years managed care Utilization Management experience
• Demonstrated experience in health plan utilization management, facility concurrent review discharge planning, and case management preferred.
• Medicare Advantage experience preferred.
• Experience with InterQual or MCG authorization criteria preferred.
• Excellent computer skills and ability to learn new systems required.
• Strong attention to detail, organizational skills and interpersonal skills required.
• Demonstrated ability to problem solve and manage professional relationships.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.