Utilization Management Nurse Consultant

📋 Description

• Review clinical documentation and patient cases to make utilization management and coverage
• Apply clinical assessment skills and professional nursing judgment to evaluate medical necessity
• Collaborate with healthcare providers and interdisciplinary care teams to facilitate appropriate
• Ensure members receive appropriate care in the right setting and at the right time while supporting
• Identify opportunities to improve clinical outcomes, operational processes, and the overall member
• Act as a clinical resource for internal colleagues, external providers, and other relevant

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in the state of residence, as specified in the
• Minimum of 3 years of professional RN experience.
• Associate Degree in Nursing (ADN) required; a Bachelor of Science in Nursing (BSN) is preferred.
• Strong clinical assessment, critical thinking, problem-solving, and decision-making skills.
• Ability to interpret clinical information, apply evidence-based criteria, and make sound
• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.

🎁 Benefits

• Fully remote, work-from-home opportunity.
• Full-time schedule of 40 hours per week.
• Competitive base pay range of $29.10–$62.32 per hour, depending on experience, education, location
• Eligibility for a bonus, commission, or short-term incentive program in addition to base
• Comprehensive benefits package, subject to eligibility, including: Medical, dental, and vision
• Company-provided computer, monitor(s), keyboard, and headset.