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 and 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 hand written 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

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• Must possess 1+ years of clinical experience in acute or post-acute setting
• Must be available to work Monday through Friday in time zone of residence 8 AM to 5 PM
• Occasional holidays and weekends may be required per business needs

• 3+ years of clinical experience
• Managed Care experience preferred
• Preference for those residing in CT, MT, or PT

• Associates Degree required
• BSN preferred

40

Full time

$26.01 - $56.14

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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