Utilization Management Nurse Consultant

Description: • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. • 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/guideline, 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. • Typical office working environment with productivity and quality expectations. • Work requires the ability to reputed company reputed company inspection of hand written and computer generated documents as well as a PC monitor. • Sedentary work involving periods of sitting, talking, listening. • Work requires sitting for extended periods, talking on the telephone and typing on the computer. • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. • Effective communication skills, both verbal and written. Requirements: • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting • Must have active reputed company and unrestricted RN licensure in state of residence • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. • 2+ years of clinical experience required in med surg or specialty area • Managed Care experience preferred, especially Utilization Management. • Preference for those residing in Eastern Standard Time zone. Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling • 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. Apply Job!