Registered Nurse Utilization Consultant

Job Summary

A company is looking for a Utilization Management Nurse Consultant (Remote).

Key Responsibilities

• Apply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review
• Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information
• Use established guidelines to authorize services or escalate to Medical Directors as needed

Required Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence required
• Minimum 5 years of relevant experience in Nursing
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
• Commitment to attend a mandatory 3-week training with 100% participation