Utilization Management Nurse Consultant

Position Summary

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Typical office working environment with productivity and quality expectations.
• Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor.
• Sedentary work involving periods of sitting, talking, listening.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

• 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
• Current and unrestricted RN licensure in state of residence.
• Work schedules will include weekends, holidays, and evening hours (24/7 operation).

• 2+ years of clinical experience in med surg or specialty area.
• Managed Care experience preferred, especially Utilization Management.
• Preference for those residing in EST zones.

Associates Degree required. BSN preferred.

40 hours per week. Full time. 24/7 operation includes weekends, holidays, and evening hours.

Pay range: $26.01 - $68.55 per hour (base). Eligible for bonus, commission, or short-term incentive program.

Eligibility for comprehensive benefits package, including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and additional resources.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.