Utilization Management Nurse Consultant – Weekends

Job Description: • 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 • Typical office working environment with productivity and quality expectations • Work requires the ability to perform close inspection of handwritten 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 Requirements: • 5 years of experience as a Registered Nurse in adult acute care/critical care setting • Must have active current and unrestricted RN licensure in state of residence • 4 - 10 hour shifts every Saturday and Sunday and two weekdays • Monday - Friday training is required prior to transferring to weekends • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours • 3+ years of clinical experience required in med surg or specialty area preferred • Managed Care experience preferred, especially Utilization Management • Preference for those residing in ET zones Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings • Tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical accessApply Now

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