Utilization Management Clinical Nurse Consultant – Licensed in Arizona

Job Description: • Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program • Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function • Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care • Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members • Coordinates and communicates with providers and other parties to facilitate optimal care/treatment • Identifies members who may benefit from care management programs or other post-discharge programs and facilitates referrals • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization Requirements: • 3+ years of experience in acute hospital clinical practice • Must have active and unrestricted RN (Registered Nurse) Licensure in the state of Arizona, or Compact RN licensure • Ability to work Monday-Friday from 8:30am-5:00pm, Arizona Time Zone Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • 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