Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
As a Utilization Management Nurse Consultant Clinical Precertification RN, you will use your clinical expertise to ensure members receive the right care at the right time.
Responsibilities
- Review clinical cases and make coverage determinations using evidence-based guidelines
- Collaborate with providers, attending MDs and care teams to complete precertification requests
- Apply clinical judgment to support utilization and benefit management decisions
- Identify opportunities to improve care quality and member outcomes
- Serve as a clinical resource across internal and external stakeholders
Requirements
- Active, unrestricted RN license in the state of residence
- 2+ years of RN experience, including 1+ year in Med/Surg
- Strong clinical assessment and decision-making skills
- Experience with Microsoft Office (Outlook, Teams, Excel)
- Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone
- Associate Degree in Nursing
Preferred Qualifications
- Utilization Management or Prior Authorization experience
- Managed care background
- Ambulatory surgery background
- BSN preferred
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
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