Utilization Management Nurse Consultant - Military Veterans

Position Summary

This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations.

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

• 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.

• Typical office working environment with productivity and quality expectations.

• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

• Sedentary work involving periods of sitting, talking, listening.

• Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

• Effective communication skills, both verbal and written

Required Qualifications

• Must reside in Eastern Standard Time zone

• Must have active current and unrestricted RN licensure in state of residence

• 3+ years of experience as a Registered Nurse

• 1+ years of clinical experience in acute or post-acute setting

• 2+ years of experience working with MS office applications such as Teams, Outlook, Excel, and Word

• Must be available to work Monday-Friday from 8 AM to 5 PM EST, 6 weekends per year with rotating Holidays, and occasional late rotation 10 AM - 7 PM EST

Preferred Qualifications

• Experience working in ER, Med/Surg, and/or Critical care setting

• Managed Care experience

• Utilization review experience

• Experience working with electronic medical record systems such as EPIC, Cerner, or Meditech

• Ability to work in a fast-paced environment while multitasking

Education

Associates Degree

BSN preferred