Utilization Management Nurse Consultant

Role Overview

• Review clinical cases and make coverage determinations using evidence-based guidelines
• Collaborate with providers and care teams to coordinate appropriate treatment
• Apply clinical judgment to support utilization and benefit management decisions
• Identify opportunities to improve care quality and member outcomes
• Serve as a clinical resource across internal and external stakeholders

Requirements

• Active, unrestricted RN license in the state of residence.
• 3+ years of RN experience, including 1+ year in Med/Surg
• Strong clinical assessment and decision-making skills
• Experience with Microsoft Office (Outlook, Teams, Excel)
• Ability to work Monday–Friday, 9:00 AM–5:30 PM in your time zone.
• Associate Degree in Nursing
• Nice to Have Utilization Management or Prior Authorization experience
• Managed care background
• Familiarity with MedCompass
• Ambulatory surgery experience
• BSN preferred

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs