Utilization Management Nurse Consultant

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Leverage clinical expertise and skills in a collaborative approach to assess, plan, implement, coordinate, monitor, and evaluate options that facilitate appropriate healthcare services and benefits for members.

• Collect clinical information and apply the relevant clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations and recommendations throughout the continuum of care.

• Engage with providers and other stakeholders to promote effective care and treatment.

• Recognize members for referral opportunities to integrate with various products, services, and programs.

• Identify chances to enhance the quality and effectiveness of healthcare services and benefit utilization.

• Provide consultation and expertise to internal and external stakeholders in managing and coordinating the utilization and benefit management functions.

⛳️ Requirements

• A minimum of 2 years of experience as a Registered Nurse in an adult acute care or critical care environment.

• Must possess an active, current, and unrestricted RN license in the state of residence.

• Utilization Management operates 24/7, and work schedules will require availability on weekends, holidays, and evenings.

• At least 2 years of clinical experience in medical-surgical or a specialty area is required.

• Experience in Managed Care is preferred, particularly in Utilization Management.

• Preference will be given to candidates residing in Eastern Standard Time (EST) zones.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources.