Nurse Consultant, Utilization Management
Description: • Utilizes clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Gathers clinical information and applies clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. • Communicates with providers and other parties to facilitate care/treatment. • Identifies members for referral opportunities to integrate with other products, services and/or programs. • Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. • Must be willing and able to work Monday through Friday, 10am to 7pm EST with occasional holiday rotation. Requirements: • 3+ years of experience as a Registered Nurse • Must have active current and unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) • Must be willing and able to work Monday through Friday, 10:00am to 7:00pm eastern time with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours. • Prior Authorization or Utilization Management experience (preferred) • Managed care experience (preferred) • Experience using MedCompass (preferred) • Ambulatory surgery experience (preferred) • Associates degree required; Bachelor's in Nursing preferred Benefits: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Apply tot his job