RN Utilization Management Consultant

Job Summary

Working remotely on a full-time basis, the RN Utilization Management Consultant will utilize clinical skills to coordinate and communicate all aspects of the utilization management program, applying critical thinking to ensure appropriate healthcare services for members.

Key responsibilities

• Coordinate, document, and communicate utilization management processes, applying medical necessity criteria and clinical judgment
• Consult with internal and external stakeholders to facilitate the administration of the utilization management function
• Identify members for care management programs and promote quality effectiveness of healthcare services

Required qualifications

• 3+ years of clinical practice experience in an inpatient setting
• RN with unrestricted state licensure
• Willingness to obtain additional state licenses
• Ability to work rotating weekends
• AA in Nursing required; BSN preferred