UM Nurse Consultant

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Utilization Management (UM) Nurse Consultant utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Responsibilities

• Gather clinical information and apply clinical criteria/guidelines, policies, procedures and clinical judgment to render coverage determinations/recommendations along the continuum of care.
• Communicate with providers and other parties to facilitate care/treatment.
• Identify members for referral opportunities to integrate with other products, services and/or programs.
• Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements

• 3-5 years of Med/Surg experience.
• 3+ years of experience as an RN.
• 1+ year of inpatient hospital experience.
• Active, current, and unrestricted RN licensure in state of residence.
• Ability to work in multiple IT platforms/systems.
• 1+ year of experience with Microsoft Office applications (Outlook, Teams, Excel).

Preferred Qualifications

• Experience with Medicare/Medicaid populations.
• MCG experience.
• Managed care experience.
• UM Certification.
• MedCompass experience.
• 1+ year of inpatient utilization experience.

Education

• Associate's degree required.
• BSN preferred.

Work from Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of computer.
• Minimum download speed of 25 mbs and upload speed of 3 mbs.
• Quiet, secure and private designated home virtual work location.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
• Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently.

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

Anticipated Weekly Hours

• 40 hours per week.

Time Type

• Full-time.

Pay Range

• $26.01 - $68.55 per hour.