Utilization Management Nurse Consultant

Job Summary

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

Key Responsibilities

• Utilizes clinical experience to implement, coordinate, monitor, and evaluate medical review cases
• Applies clinical criteria and guidelines to render medical determinations
• Assists in training new nurse reviewers and recommends process improvements

Required Qualifications

• Active, unrestricted RN license with multistate/compact licensure privileges
• Minimum 3 years of clinical experience
• 5 years of demonstrated independent decision-making using clinical judgment
• 1+ year of Utilization Review Management and/or Medical Management experience
• Commitment to attend a mandatory 3-week training with 100% participation