Utilization Management Nurse Consultant

Job Summary

Utilization Management Nurse Consultant will work full-time in a fully remote capacity, utilizing clinical expertise to assess, plan, implement, and evaluate healthcare services for members while collaborating with providers and facilitating care coordination.

Key responsibilities

• Assess and apply clinical criteria to render coverage determinations and recommendations for healthcare services
• Communicate with providers and other stakeholders to facilitate care and identify referral opportunities
• Consult on utilization management processes and promote the effective use of healthcare services

Required qualifications

• 3+ years of experience as a Registered Nurse (RN)
• Active and unrestricted RN licensure in the state of residence
• Experience with multiple IT platforms and systems
• 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
• Associates Degree in Nursing required; BSN preferred