---
title: 'Contract Utilization Management Nurse at IntusCare'
canonical: 'https://feeny.ai/job/contract-utilization-management-nurse-intuscare-united-states-zgta6cqedpkd'
type: 'job'
last_seen: '2026-09-11'
---

# Contract Utilization Management Nurse at IntusCare

- **Company:** IntusCare
- **Location:** United States
- **Employment:** full-time
- **Work type:** remote
- **Posted:** 2026-07-27
- **Last confirmed live:** 2026-09-11
- **Apply:** https://jobs.ashbyhq.com/intus/a7a2b360-d0bd-45ea-a275-7876a8dec85e

## Job description

## About IntusCare

IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual workarounds with purpose-built solutions for care coordination, risk adjustment, population health, and utilization management. IntusCare empowers teams to take control of their operations and improve outcomes for dual-eligible seniors – some of the most socially vulnerable and clinically complex individuals in the US healthcare system.

## Role Overview

The Contract Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual partners closely with PACE Interdisciplinary Teams, Medical Directors, and provider networks to review service utilization, guide care decisions and support timely, appropriate transitions across care settings. Blending clinical expertise with analytical thinking, the Utilization Management Nurse ensures services are medically necessary, aligned with care plans and consistent with PACE regulations and best practices. This role is essential to maintaining program integrity, improving participant outcomes and supporting the delivery of coordinated, value-based care.

## Responsibilities

- Rigorous adherence to PACE program service authorization policies, ensuring that participant care and related claims are:
- Reasonable and necessary for diagnosis or treatment and consistent with PCP coordination decisions.
- In accordance with accepted medical standards and consistent with the participant care needs including level of care and advanced care planning principles.
- Active involvement in various aspects of the utilization management process, including:
- Concurrent review of all hospital admissions (observation and inpatient) with the Interdisciplinary Team driving efficient and timely transitions of care, retrospective review of inpatient admissions under 48 hours, and claims submitted inconsistent with the service authorization.
- Concurrent review of all subacute and SNF admissions with the Interdisciplinary Team driving efficient and timely discharge plans and transitions of care.
- Coordination and review of all other services delivered by contracted providers and identified by the PACE program assuring consistency with Interdisciplinary Team service authorization, care plans, and PCP coordination decisions.
- Employ effective use of knowledge, critical thinking, and skills to:
- Advocate quality care and enhanced quality of life
- Advocate decreased hospital stay when appropriate
- Maintain accurate records of all patient related interactions
- Appeal Management - In cases of claim rejection, the IntusCare Utilization Management Nurse will lead the provider appeals process. Responsibilities Include:
- Comprehensive review of provider network appeals.
- Collaboration with the PACE Program's Medical Director to review and respond to appeal requests, ensuring issuance of a written determination consistent with the PACE program policies.

## Qualifications

- 3 to 5 years of utilization management experience.
- Current RN license
- Proven experience working in risk based integrated models of care.
- Ability to use data to drive decisions and collaboration with internal and external stakeholders.
- Strong strategic thinking, problem solving, and decision making skills.
- Excellent communication and leadership abilities, capable of motivating and guiding teams toward timely and efficient care management strategies

## What We Offer

- 1 year contract with the possibility of extension
- A chance to be a part of a trailblazing team in healthcare technology.
- A collaborative, inclusive, and dynamic work environment.

Compensation: The range for this role is $42.00/Hour. Work location: This is a fully remote role based in the United States. Sponsorship: This position is not eligible for sponsorship.

## About IntusCare

## Company Overview
- **One-liner**: IntusCare provides an integrated technology ecosystem of EMR, population health, risk adjustment, and compliance solutions built specifically for PACE (Program of All-Inclusive Care for the Elderly) programs.
- **Entity Type**: Private (funding stage: Series A, total raised $45.89M)
- **Headquarters**: Providence, Rhode Island, United States
- **Founded**: 2019
- **Founders**: Robbie Felton (CEO), Evan Jackson (CFO), Alex Rothberg (Co-Founder & Technology Leader)

## Core Business
- **Primary industry**: Healthcare technology (PACE-focused software and analytics)
- **Target customers**: B2B – PACE organizations (health plans and care providers serving dual-eligible seniors)
- **Mission**: “Ensure every older adult receives the compassionate, high-quality care they deserve, empowering them to age with dignity and independence.”

## Products & Services
- **CareHub**: Comprehensive EMR designed for PACE – streamlines interdisciplinary workflows, embeds compliance requirements, integrates with pharmacy/TPA/clinical partners, and supports care coordination and operations.
- **IRIS**: Population health and utilization management technology and services to align high-quality care with financial stability.
- **ILLUMINATE**: AI-powered risk adjustment technology to capture accurate reimbursement.
- **PRISM**: Compliance services to track risk, remediation, and sustain regulatory alignment.

All products are purpose-built for PACE and work together as a single ecosystem.

## Market Standing
- **Valuation/Market Cap**: Not publicly disclosed
- **Key Metric**: Total funding raised – $45.89M (as of latest round)
- **Notable Investors/Partners**: Not explicitly named in provided sources, but the company has raised $11.5M and $14M in Series A funding; serves 70+ PACE programs across the U.S.
- **Growth Signals**: CareHub EMR launched in 2025 and expanded to 33 PACE programs across 16 states in its first year; overall now serving 70+ programs and 50,000 participants nationwide; team has grown across commercial, product, and engineering departments.

## Competitive Advantages
- **Purpose-built for PACE**: The only technology ecosystem built specifically for PACE, by people with deep domain knowledge (founders studied PACE operations at Brown University).
- **Full-stack integration**: Combines EMR, population health, risk adjustment, and compliance – eliminating fragmented point solutions and reducing data chasing and spreadsheet work.
- **Proven outcomes**: Reported reductions in SNF admissions, inpatient readmissions, and ED-to-IP admissions among partner programs.
- **Compliance-first design**: Workflows embed regulatory requirements, reducing audit risk and penalties.

## Strategic Focus
- **Scale platform adoption**: Continue expanding CareHub EMR and the full ecosystem to more PACE organizations nationwide.
- **Deepen product capabilities**: Ongoing innovation across risk adjustment, population health, and compliance to drive better clinical and financial outcomes.
- **Strengthen partner ecosystem**: Integrate with critical pharmacy, TPA, and clinical partners to reduce friction for PACE teams.

## Why Work Here
- **Remote-first culture**: Work from anywhere in the United States, with optional office hubs in Boston and New York; work-from-home stipend provided.
- **Flexible time off**: Unlimited PTO plus 15 holidays; paid parental leave.
- **Comprehensive benefits**: Company-sponsored medical, dental, and vision coverage for employees and dependents; monthly health & wellness stipend; annual learning & development stipend.
- **Core values**: Data-driven decision-making, ownership, support for each other, passion for impact, and continuous growth.
- **Mission-driven**: Direct impact on improving care for vulnerable older adults – employees describe the work as “crushing complexity” to let care teams focus on participants.
- **Commitment to DEI**: Inclusive workplace where diverse perspectives are valued and embedded in how the company operates.

## Sources
1. [intuscare.com](https://intuscare.com/) – Company homepage and product overview
2. [intuscare.com/about](https://intuscare.com/about-intuscare/) – About page with founding story, timeline, and leadership
3. [intuscare.com/careers](https://intuscare.com/careers/) – Careers page with culture, perks, and values
4. [cbinsights.com](https://www.cbinsights.com/company/intus-care) – Company profile with funding, headquarters, and recent news
5. [linkedin.com](https://www.linkedin.com/company/intuscare) – LinkedIn page for basic verification

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- [Utilization Management Nurse](https://feeny.ai/job/utilization-management-nurse-intuscare-united-states-yq55ecfhhspb) — United States
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