Remote Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse Consultant specializing in Medical Review (Remote).

Key Responsibilities

• Implement, coordinate, monitor, and evaluate medical review cases using clinical expertise
• Apply clinical criteria and guidelines to make medical determinations for clients
• Assist in training new nurse reviewers and recommend process improvements to enhance quality and client satisfaction

Required Qualifications

• Active, unrestricted RN license with multistate/compact licensure privileges
• Minimum 3 years of clinical experience
• 5 years of experience making independent clinical decisions
• 1+ year of Utilization Review Management and/or Medical Management experience
• Commitment to a mandatory 2-week training program