Utilization Management Nurse Consultant

Description:
? Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
? Fully remote work from home in CST zone.
? No travel is required.
? 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: ? Must reside in CST zone. ? 3+ years of experience as an RN. ? 1+ year of inpatient/outpatient hospital experience, specifically Med/Surg. ? Must have active, current and unrestricted RN licensure in state of residence. ? 1+ years of experience working in multiple IT platforms/systems. ? 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel). ? Must be willing and able to work Monday through Friday 8:00 am to 5:00 pm CST with rotating late evening and weekend shifts.

Benefits:
? Full range of medical, dental, and vision benefits.
? 401(k) retirement savings plan.
? Employee Stock Purchase Plan.
? Fully-paid term life insurance plan.
? Short-term and long-term disability benefits.
? Numerous well-being programs.
? Education assistance and free development courses.
? CVS store discount.
? Paid Time Off (PTO) and paid holidays.

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