Utilization Management Nurse Consultant

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

📋 Description

• Utilize critical thinking and evidence-based clinical criteria to assess outpatient and inpatient services that require precertification and concurrent review.

• Perform clinical evaluations through phone calls and electronic documentation, collaborating with healthcare providers to obtain essential information.

• Apply established guidelines to authorize services or escalate to Medical Directors when necessary.

• Efficiently navigate various computer systems while ensuring accurate documentation.

• Excel in a dynamic, high-volume environment with strong organizational, multitasking, and prioritization abilities.

• Ensure continuity of care and operational support as a Utilization Management (UM) Nurse across different UM specialty teams as required.

• Participate in occasional on-call rotations, including weekends and holidays, in accordance with URAC and client stipulations.

⛳️ Requirements

• Active, unrestricted state Registered Nurse licensure in the state of residence is mandatory.

• A minimum of 5 years of pertinent experience in Nursing is required.

• At least 1 year of experience in Utilization Management relating to concurrent review or prior authorization is essential.

• Strong decision-making capabilities and clinical judgment in independent scenarios are needed.

• Proficient in using phone systems, clinical documentation tools, and navigating multiple digital platforms.

• A commitment to complete a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with full participation is required.

🏝️ Benefits

• Medical, dental, and vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Other resources, based on eligibility