Utilization Management Nurse Consultant

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

📋 Description

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

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

• Engages with providers and other stakeholders to facilitate care and treatment.

• Identifies members for potential referral opportunities to integrate with additional products, services, and/or programs.

• Recognizes opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.

• Provides consultation and expertise to both internal and external stakeholders concerning the coordination and administration of the utilization and benefit management functions.

• Typical office working environment with expectations for productivity and quality.

• Requires the ability to closely inspect handwritten and computer-generated documents, as well as a PC monitor.

• Involves sedentary work that includes periods of sitting, talking, and listening. The role requires extended periods of sitting, talking on the phone, and typing on a computer.

• Ability to manage multiple tasks, prioritize effectively, and adapt to a fast-paced, changing environment.

• Proficiency in computer skills is necessary, including navigating multiple systems and keyboarding.

⛳️ Requirements

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

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

• Utilization Management operates 24/7, requiring work schedules that include weekends, holidays, and evening hours.

• At least 2 years of clinical experience in medical-surgical or specialty areas is preferred.

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

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.