Utilization Management Nurse Consultant – Medicaid Program
Job Description: • Create, review, and audit medical determination letters including approvals, extensions, and denials • Ensure all documentation meets regulatory, accreditation, and internal quality standards • Support effective medical management by facilitating clear communication across internal teams and external partners • Maintain accurate, complete records for compliance and risk‑management requirements • Contribute to overall quality and effectiveness of healthcare services through attention to detail and process consistency Requirements: • Registered Nurse (RN) with an active, unrestricted license in the state of residence • 1+ year of clinical nursing experience • Experience in Utilization Management or Managed Care (Preferred) • Strong grammar, writing, and editing skills (Preferred) • Ability to multi‑task and work efficiently in a fast‑paced environment (Preferred) • Associate or Bachelor’s degree in Nursing (Preferred) 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 • 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