Utilization Management Nurse Consultant (UMNC)

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

This Utilization Management Nurse Consultant (UMNC) position is a work-from-home position, fully remote, with flexible working hours in your time zone of residence.

As a Utilization Nurse Consultant, you will utilise clinical skills to coordinate, document, and communicate all aspects of the utilisation/benefit management program.

Responsibilities:

• Utilise clinical skills to coordinate, document, and communicate all aspects of the utilisation/benefit management program.
• Apply clinical expertise to ensure appropriate benefit utilisation and facilitate safe and efficient discharge planning.
• Collaborate with providers and facilities to meet the complex needs of members.
• Review services to assure medical necessity and apply clinical criteria/guidelines.
• Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilisation.

Requirements:

• Active, current, and unrestricted RN license in your state of residence.
• 2+ years of recent acute hospital clinical experience as an RN.
• 1+ year of experience with Microsoft Office, including PowerPoint, Excel, and Word.
• Ability to work Monday through Friday, 8:00 am - 4:30 pm in your time zone of residence.
• Willingness to work weekend and holiday rotation as needed.

Preferred Qualifications:

• Utilisation Review experience.
• Managed Care background.
• Strong telephonic communication skills.

Education:

• Associate's Degree in Nursing required.
• Bachelor's in Science & Nursing preferred.

Benefits:

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

Salary Range: $26.01 - $56.14 per hour.