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Job DescriptionAbout us: Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked and each employee is valued. Please check out our company website at to learn more about us! Bilingual in English and Spanish is required Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match! Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members! Join our winning Solis Team! Position is fully onsite Monday-Friday. Location: 9250 NW 36th St, Miami, FL 33178. Position Summary: Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) uses a multidisciplinary approach to organize, coordinate, monitor, evaluate, create and manage organization determinations and authorizations. These service requests will focus on selected complex medical and psychosocial needs of Solis Health Plans members. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Solis Health Plans benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination. Main Key Responsibilities: • Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services., • Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status., • Work with Medical Directors, Program Leadership and Solis Health Plans Provider Relations Teams to identify and mitigate facility barriers associated with the ability to make timely decisions., • Identify, align and utilize health plan and community resources that impact high-risk/high cost care., • Act as liaison between assigned facilities, members/families, and Solis Health Plans. Clarify policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed., • Assess enrollee needs and monitor progress toward goals at all times, communicating findings and status with members of the enrollee’s primary care team., • Ensure optimal delivery of safe quality health care to members, while maximizing resources and containing costs, and facilitate continual patient-centered and outcome-driven health performance improvement activities., • Review enrollees with the Medical Directors and Primary Care Teams and advocates for Administration Exception considerations as appropriate., • Graduate from an accredited school of nursing, or Bachelors (or advanced) degree in nursing., • Active and unrestricted licensure as a Registered Nurse in Florida., • A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required., • 2 years’ experience as a Utilization Management nurse in a managed care payer preferred., • One year experience as a case manager in a payer or facility setting highly preferred., • Discharge planning experience highly preferred. What Sets Us Apart: Join Solis Health Plans as a Utilization Management Nurse and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!

Job Description VieMed Healthcare is the largest independent specialized provider of non-invasive ventilation (NIV) in the US home respiratory health care industry. We specialize in treating the most challenging respiratory patients inside the home by pairing the best-in-class technology & equipment with the clinical care of a full-time Respiratory Therapist. We are always aiming to be the leading provider in post-acute in-home care with the implementation of palliative services. Our Disease Management program has earned national attention, making us the number one independent ventilation provider in the United States. In recent random studies of our patient population, we have shown a 30-day COPD re-admission rate of 5.7% compared to the industry average of 20-22%*. Over 93% of our patients share that they actually “Breathe Better” on our treatment program! While our Respiratory Therapists provide the highest level of clinical care and support for our patients, our Sales Representatives work in conjunction with healthcare decision-makers to ensure a comfortable transition for the patient from the hospital to their home. This achieves better management of the length of stay and re-admission rates to hospitals, which reduces costs for patients and brings personalized clinical care directly to the patient from the comfort of their own home. Our mission is to educate, nurture, and inspire our patients to lead better lives. Position Summary: This position is a field-based, business development, hands-on clinical sales position that requires a candidate with the drive and skill to be a patient advocate, and positive representative of VieMed. This position is responsible for identifying & initiating one-on-one dialog with new potential referral sources and maintaining positive relationships with existing referral sources. They will leverage their clinical and sales expertise to design/develop cutting edge sales strategies to drive VieMed’s disease management program and respiratory products to new market potential to grow the business within the assigned territory. The candidate will spend most of their time (80% or more) in the field: networking, building relationships, and educating referral sources* within the hospital on all the benefits of VieMed’s disease management program will improve the lives of their patients with Chronic Respiratory Failure. Hospital Referral Sources: Pulmonologist, Hospitalist, Critical Care Physicians, Case Managers, and Social Workers. Essential Sales Duties and Responsibilities: • Market VieMed’s disease management program to potential and existing referral sources, • Develop sales territory action plans and call strategies to maintain ongoing business with current accounts and apply working knowledge of clinical, consultative, and strategic selling skills to drive new market potential to grow the business within assigned territory, • Coordinate and provide educational presentations and in-services for healthcare providers, • Responsible for account activity, sales documentation, reports, and territory management, • Partners with all clinical, managerial, sales staff, and other internal departments within to promote and market our home respiratory therapy services to all referral sources to drive sales growth, • Works with the office staff to ensure prompt and accurate billing and documentation of services, including providing adequate information to satisfy third-party payor guidelines for coverage, • Required to provide availability for patient contact and response to patient needs, • Maintain a level of performance that meets or exceeds the sales quotas, • Demonstrated ability to build and maintain solid working relationships with internal and external referral sources geographically located within assigned territory, • Exhibits effective oral and written communication with physicians, location staff, patients, and all referral sources to ensure questions and concerns are processed promptly, • Ability to plan, implement, and execute strategies independently to achieve sales goals effectively, • Exhibit a sense of urgency for goal achievement with a strong commitment to results, • Builds relationships with referral sources, patients, and caregivers, • Strong organizational, prioritizing, and territory management skills The qualified candidate: • Must be a resourceful problem solver who thrives in a fast-paced environment., • Must be well-connected and have established relationships with the Pulmonary, Critical Care, & Hospitalist physicians within the territory (required), • Must be able to provide three informal letters of recommendation from Pulmonologist (required), • A proven track record of successful sales experience in a health care setting, and experience working with physicians, nursing management, discharge planners, case managers, and social workers, • Two or more years demonstrated full life cycle healthcare sales experience from lead generation, educating the referral source, persistent follow-up, and follow through on all leads, issues, and success stories, • Two or more years of experience as a Clinical Liaison, preferably within the LTACH level of care, • Previous marketing and/or LTACH marketing experience, • Previous clinical/clinical liaison experience preferred with demonstrated skills in clinical patient assessment, • The preferred applicant would be a Respiratory Therapist or Nurse with Adult Critical Care experience with business development/physician marketing experience or have a proven sales record in the local Home Medical Equipment market, • Sales: This job operates in the field by calling on, marketing to both existing and potential referral sources:, • Competitive Base Salary, • Uncapped Commissions, • Excellent Orientation Program, • Health, Dental, & Vision Insurance, • PTO, • 401K Retirement Plan, • Monthly Cell Phone Allowance, • Marketing Allowance, • Life Insurance