Utilization Management Nurse Consultant

Role Overview

• Review clinical documentation and apply criteria to support coverage determinations
• Collaborate with providers and care teams to coordinate appropriate care
• Identify opportunities to improve care quality and effective benefit utilization
• Connect members to programs and services that enhance outcomes
• Serve as a clinical resource to internal and external stakeholders

Requirements

• Active, unrestricted RN license in your state of residence
• 2+ years of adult acute care or critical care experience
• Strong clinical judgment and effective communication skills
• Ability to multitask and work efficiently in a fast-paced, technology-driven environment
• Experience in Med-Surg or a specialty area (preferred)
• Managed Care or Utilization Management experience (preferred)

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package