Utilization Management Nurse Consultant - Eastern Time Zone
$66,581–$142,584 year
RemoteMassachusetts, United States
Job Summary
Review services to assure medical necessity and apply clinical expertise to ensure appropriate benefit utilization. Coordinate, document, and communicate all aspects of the utilization/benefit management program while reviewing written clinical records. Gathers clinical information to apply criteria and guidelines for coverage determinations and recommendations along the continuum of care. Communicates with providers to facilitate treatment and consults with internal and external constituents on the utilization/benefit management function. Identifies members for referral opportunities and promotes quality effectiveness of healthcare services. Requires an active RN license, 3+ years of clinical experience, and residence in the Eastern Time Zone. Full-time remote work with occasional weekend and evening shifts.
Required Qualifications
- RN with active and unrestricted state licensure in state of residence
- 3+ years of clinical experience as an RN
- Candidates must live in the Eastern Time Zone
- Associates Degree in Nursing
- BSN preferred
Desired Qualifications
- 1+ years' experience in either Precertification or Utilization Review
- 1+ years' experience Managed Care
- Strong telephonic communication skills
- 1+ years' experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook)
- Experience with computers toggling between screens while using a keyboard and speaking to customers
- Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills
- Ability to manage multiple priorities, effective organizational and time management skills
- Ability use a computer station and sit for extended periods of time
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