Role Description

Your north star: Develop Pomelo’s program to optimize NICU utilization across Pomelo’s patient population, ensuring appropriate and cost-effective care.

Pomelo supports payers in ensuring evidence-based, cost-effective care. In this role, you will design Pomelo’s end-to-end utilization review program, from identifying patients, to aggregating relevant clinical information and reviewing charts to assess appropriateness of NICU care, to developing processes for flagging potential over or under utilization to health plan partners. The ideal candidate has experience performing NICU utilization review and is excited to build a novel UM program from the ground up. Additionally, you’ll be responsible for coordinating NICU case management, guiding NICU families throughout the care continuum in conjunction with the clinical team.

NICU Utilization Management

• Develop and implement NICU program, focused on supporting patients, improving outcomes and reducing NICU length of stay
• Review and analyze NICU utilization data, including claims if available, to assess the appropriateness and medical necessity of services rendered
• Identify instances of potential overuse, underuse, or inappropriate utilization of NICU services

NICU Case Management

• Serve as a central point of contact for NICU families throughout the care continuum
• Lead patients through a NICU discharge checklist to prepare for a timely discharge
• Support families with transitions home, including working with hospital discharge coordinator and patient leading up to and in the days of transition
• Collaborate with other Pomelo clinicians, including neonatologists, lactation consultants, perinatal mental health specialists, to ensure that evidence-based protocols are utilized in treatment plan

Who you are

• Bachelor's degree in healthcare administration, nursing, or a related field. Master's degree preferred.
• Extensive experience in NICU utilization management for a health plan or other related company
• Strong knowledge of healthcare regulations, compliance, and reimbursement methodologies.
• Proficiency in analyzing healthcare data, claims, and utilization metrics.
• Excellent analytical and critical-thinking skills, with the ability to identify trends, patterns, and opportunities for improvement.
• Meticulous attention to detail
• Comfort with ambiguity
• Passionate about maternal and child health

Why you should join our team

By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup where you will have a profound impact on the patients we serve. And you'll learn, grow, be challenged, and have fun with your team while doing it.

We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first. We also offer:

• Competitive healthcare benefits
• Generous equity compensation
• Unlimited vacation
• Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)

At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.

Our salary ranges are based on paying competitively for our company’s size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current salary range is $100,000-$120,000. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash.