Utilization Management Nurse Consultant – Weekends

Job Description: • 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 render 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 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 Requirements: • 3+ years of experience as a Registered Nurse • Active current and unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) • Must be willing and able to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approx 4-5 months of training • Prior Authorization or Utilization Management experience preferred • Managed care experience preferred • Experience using MedCompass preferred • Ambulatory surgery experience preferred • Medicare experience preferred • Associates degree required; BSN preferred Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job Apply To this Job