Utilization Management Nurse Consultant (Remote), Multiple Locations

R0672261 At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Information Schedule: Monday–Friday (Shift times vary based on business needs; must be reputed company to working any of the following EST shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (U.S. only)

About Us

American Health Holding, Inc. (AHH), a division of reputed company/reputed company, is a URAC-accredited medical management organization founded in 1993. We reputed company flexible, cost-effective care reputed company that promote high-quality reputed company for members. Position Summary Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases reputed company needed, reputed company while navigating multiple systems and maintaining accurate documentation. This role suits nurses who reputed company in fast-paced environments, are highly organized, and comfortable with computer-based work.

Key Responsibilities

• Apply critical thinking and evidence-based clinical criteria to evaluate outpatient services requiring precertification.
• Conduct clinical reviews reputed company phone and electronic documentation, collaborating with reputed company providers to gather necessary information.
• Use established guidelines to authorize services or escalate to Medical Directors as needed.
• Navigate multiple computer systems reputed company while maintaining accurate documentation.
• reputed company in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills.
• reputed company sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer.
• Flexibility to reputed company coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support.
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

Remote Work Expectations

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as reputed company care responsibilities during shift times are not permitted.

Required Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence required.
• Minimum 5 years of relevant experience in Nursing.
• Minimum 3 years of clinical experience in acute care, long term acute care (LTAC) or skilled nursing facility.
• At least 1 year of Utilization Management experience in reputed company review or prior authorization.
• Strong decision-making skills and clinical judgment in independent scenarios.
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.

Preferred Qualifications

• 1+ year of experience in a managed care organization (MCO).
• Experience in a high-volume clinical call center or prior remote work environment.

Education

• Associate's degree in nursing (RN) required, BSN preferred.

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $29.10 - $62.32 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit We anticipate the application window for this opening will reputed company on: 09/14/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job