Job Summary: As a Utilization Management Nurse Consultant, you will utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.

Responsibilities:

• Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products, services, and programs.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements:

• 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.
• Active current and unrestricted RN licensure in the state of residence.
• Must reside in EST or CST.
• Utilization Management is a 24/7 operation, and work schedules will include weekends, holidays, and evening hours.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Communication Tools: Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently.

Work from Home Requirements:

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.
• Quiet, secure, and private designated home virtual work location.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

Preferred Qualifications:

• 2+ years of clinical experience in med surg or specialty area.
• Managed Care experience preferred, especially Utilization Management.

Education:

• Associate's Degree required.
• BSN preferred.

Anticipated Weekly Hours: 40

Pay Range: $29.10 - $62.32

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