Utilization Management Nurse Consultant

Review clinical information and apply guidelines to make coverage determinations across the care continuum. Collaborate with providers and internal teams to coordinate care and support treatment plans. Identify opportunities to enhance quality, efficiency, and member outcomes by referring members to appropriate programs, services, and resources. Serve as a clinical expert in utilization and benefit management while maintaining strict attention to detail and productivity standards in a fast-paced, technology-driven remote environment. Requires an active, unrestricted RN license with 2+ years in adult acute or critical care. Full-time, 40-hour schedule from 8:00 am to 5:00 pm, including evenings, weekends, and holidays, with a preference for CST or MT time zones.