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 Now
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 Now