Utilization Management Nurse Consultant

Utilization Management Nurse Consultant working from home to apply clinical nursing skills across the care continuum. You will assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members, using clinical criteria and professional judgment to render coverage determinations. You will communicate with providers and other parties to coordinate care, identify referral opportunities, and contribute to quality and effectiveness of Healthcare Services and benefit utilization. You will consult with internal and external stakeholders in the administration of the utilization/benefit management function, supporting a 24/7 operation with schedules including holidays and evenings. This role requires active RN licensure, 3+ years of RN experience, and targeted experience in infertility or women's health, along with proficiency in Microsoft Office applications (Outlook, Teams, Excel). A Bachelor's degree in Nursing is preferred. The role offers comprehensive benefits and is full-time with a standard Mon-Fri schedule in the relevant time zone.