Utilization Management Nurse Consultant

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

📋 Description

• Employ clinical expertise to manage, document, and communicate all facets of the utilization and benefit management program.

• Ensure that members receive appropriate care at the right time and place based on established criteria.

• Examine both written and electronic clinical records.

• Assess services to confirm medical necessity.

• Utilize clinical knowledge to ensure proper benefit utilization.

• Support safe and effective discharge planning.

• Collaborate closely with facilities and providers to address the complex needs of members.

⛳️ Requirements

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

• A minimum of 3 years of clinical experience in an acute hospital setting as a registered nurse.

• Proficient in using a computer station with multiple screens, managing several programs at once, and sitting for extended periods.

• A private designated workspace that is free from distractions and equipped with high-speed internet.

• Must be willing and able to work Monday through Friday from 8 am to 5 pm EST, with occasional weekend on-call duties and holiday rotations.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.