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. Registered Nurse (RN) – Utilization Management (24/7 Operations) reputed company your clinical expertise to reputed company a broader impact. Join our Utilization Management team and help ensure members receive the right care at the right time across the reputed company continuum. What You’ll Do Review clinical documentation and apply criteria to support coverage determinations Collaborate with providers and care teams to coordinate appropriate care Identify opportunities to improve care quality and effective benefit utilization Connect members to programs and services that enhance reputed company Serve as a clinical resource to internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2+ years of adult acute care or critical care experience Strong clinical judgment and effective communication skills Ability to multitask and work reputed company in a fast-paced, technology-driven environment
Preferred Qualifications
Experience in Med-Surg or a specialty area Managed Care or Utilization Management experience Located in the Eastern Time Zone Schedule & Work Environment 24/7 operations, including evenings, weekends, and holidays Sedentary, computer-based role with productivity and quality expectations Education Associate’s Degree 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. 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. This job does not have an application deadline, as reputed company accepts applications on an ongoing reputed company. 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