Utilization Management Nurse Consultant

Description:
?? Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
?? Fully remote work from home in CST zone.
?? No travel is required.
?? 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.
?? Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
?? Communicates with providers and other parties to facilitate care/treatment.
?? Identifies members for referral opportunities to integrate with other products, services and/or programs.
?? Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
?? Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements: ?? Must reside in CST zone. ?? 3+ years of experience as an RN. ?? 1+ year of inpatient/outpatient hospital experience, specifically Med/Surg. ?? Must have active, current and unrestricted RN licensure in state of residence. ?? 1+ years of experience working in multiple IT platforms/systems. ?? 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel). ?? Must be willing and able to work Monday through Friday 8:00 am to 5:00 pm CST with rotating late evening and weekend shifts.

Benefits:
?? Full range of medical, dental, and vision benefits.
?? 401(k) retirement savings plan.
?? Employee Stock Purchase Plan.
?? Fully-paid term life insurance plan.
?? Short-term and long-term disability benefits.
?? Numerous well-being programs.
?? Education assistance and free development courses.
?? CVS store discount.
?? Paid Time Off (PTO) and paid holidays.

Apply Job!