Utilization Management Nurse Consultant

Description: • This is a fulltime remote Utilization Review opportunity. • Working hours are four 10hr days including every Weekend , both Saturday and Sunday, and two reputed company shifts of 10hrs each (Wednesday/Friday). • 12.5% Shift Premium applies once M-F training schedule completed and UMNC participating in non-traditional, weekend shift rotation. • 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 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 benefit 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. • UMNC meets set productivity and quality expectations. • Effective communication skills, both verbal and written. Requirements: • Active and unrestricted Registered Nurse in state of residence • 3+ years of experience as a Registered Nurse • 1+ years of clinical experience in acute setting (ex: ER, triage, ICU, Med/Surg) • Willing and able to work four 10hr days including every Weekend, both Saturday and Sunday, and two reputed company shifts of 10hrs each (Wednesday/Friday), also includes Holiday and late rotations. 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 and 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 access and many other benefits depending on eligibility. Apply Job!