Utilization Management Nurse Consultant – Medical Review

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

📋 Description

• Leverages clinical expertise and skills within a collaborative framework to implement, coordinate, monitor, and evaluate medical review cases.

• Utilizes the relevant clinical criteria/guidelines and policy specifics to make medical determinations for clients.

• Employs critical thinking alongside evidence-based clinical criteria and clinical practice guidelines.

• Med Review nurses apply specific criteria to authorize services or procedures, or to initiate a referral to a Medical Director when necessary.

• Supports management in training new nurse reviewers, business partners, or vendors, including providing initial and ongoing mentoring and feedback.

• Engages in cross-training to review various case types, ensuring a flexible workforce to address client needs.

• Suggests, tests, and implements process enhancements, new audit concepts, and technological improvements that boost production, quality, and client satisfaction.

• Must be capable of working autonomously without personal distractions to fulfill quality and metric expectations.

⛳️ Requirements

• Current, unrestricted RN license in your state of residence with multistate/compact licensure privileges.

• Ability to acquire licensure in non-compact states as required.

• At least 3 years of clinical experience.

• 5 years of proven ability to make comprehensive independent decisions utilizing clinical judgment.

• 5 years of proficient experience with equipment including phones, computers, and clinical documentation systems.

• 1+ year of experience in Utilization Review Management and/or Medical Management.

• Willingness to participate in a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with full attendance required.

🏝️ Benefits

• Medical, dental, and vision coverage

• Paid time off

• Retirement savings options

• Wellness programs