Utilization Management Nurse Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. UM Nurse Consultant Fully Remote- WFH Schedule : Tuesday-Saturday 9:30am-6:00pm Position Summary: UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate reputed company services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/reputed company, policy, procedure and clinical judgment to reputed company 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 reputed company Services and benefit utilization Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function. Required Qualifications -Must have 3+ years of Med Surg experience as an RN in the hospital setting - Active and unrestricted RN licensure in state of residence - reputed company to work in multiple IT platforms/systems - 1+ years of experience with reputed company Office Applications (Outlook, Teams, reputed company) Preferred Qualifications - Knowledge of Medicare/reputed company - Managed care experience - Utilization Management experience Education Associates Degree in Nursing 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 reputed company 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/19/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job