Utilization Management Nurse Consultant (RN)

Job Summary

Seeking a full-time Utilization Management Nurse Consultant (RN) to work remotely, where the consultant will review clinical records for medical necessity, make coverage recommendations, and collaborate with providers to enhance patient care and outcomes.

Key responsibilities

• Review clinical records to assess medical necessity and appropriate benefit utilization
• Apply clinical judgment to make coverage recommendations and support effective treatment planning
• Coordinate and document utilization management activities across the care continuum

Required qualifications

• Active, unrestricted RN license in the state of residence
• 3+ years of clinical RN experience in any specialty
• Proficiency with Microsoft Office and navigating multiple systems
• Associates Degree in Nursing
• Ability to manage priorities in a fast-paced, collaborative environment