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.
· We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
· Our customers like us. Our revenue churn is in the low single digits, in an industry where greater than 20% churn is common.
· 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 a Registered Nurse with Health Plan Operations and cost containment experience. You’ll take what we’re doing - creating a health plan people will love – and utilize your clinical skills and health plan experience to create, coordinate, and communicate evidenced based practices into operations. You’ll work directly with our Clinical Services, Claims, Stop Loss, Gravie Care, external partners including contracted networks, and Reporting teams to create SOPs and help others make equitable decisions.
You will:
· Be a key lead to collaborate and bridge the clinical team and health plan operations team to guide care for members and assist with applying benefits according to plan language.
· Utilize your clinical experience in a collaborative way to assess appropriateness of treatment plans, apply evidenced based standards, and build SOPs where appropriate.
· Monitor, evaluate, and coordinate options to facilitate appropriate benefits for members.
· Gather and assess clinical information through medical records, case management, and other source information to apply appropriate clinical judgment for benefits coverage.
· Experience with and a depth of understanding of medical policies so you can help create and standardize operations for medical policies at Gravie.
· Deep understanding of Transition of Care, Continuity of Care, utilization management (UM), Prior Authorizations (PAs), Medical Necessity, appeals, claims reviews, gap exceptions, and application of benefits.
· Lend expertise across the company to consult and provide administration support of UM, PAs, medical necessity, and appeal functions.
· Review pre-certification lists for holistic Utilization Management.
· Work with network Utilization Management/Case Management vendors to reduce errors and improve accuracy for both member and provider experience.
· Use your experience and understanding of Fraud, Waste, and Abuse to perform internal audits of claims and suggest policies and procedures to reduce this risk.
· Understand and suggest cost containment opportunities and strategies.
· Think critically about plan language to clarify coverage and make the member journey as seamless as possible.
· 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.
· Combine your experience of evidenced based practice with being innovative to drive new solutions for the best member experience.
· Create effective relationships, listen, communicate and be a helpful team member across the organization.
You bring:
· Bachelor’s degree in nursing
· Active RN or NP license in the state hired.
· Experienced with health plan operations, preferably with a third-party administrator (TPA) or health plan.
· 5+ years’ experience in nursing
· 3+ years’ experience with UM and/or medical record reviews
· 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, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.
