Utilization Management Nurse Consultant
We’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues.
Position Summary
This utilizes an independent 100% remote role in which you coordinate, document, and communicate all aspects of the utilization/benefit management program for our plan sponsor(s). You will review written and electronic clinical records to determine medical necessity and appropriate benefit utilization, ensure members receive the appropriate care at the appropriate time and location, and facilitate safe and efficient discharge planning. You will work closely with facilities and providers to meet complex member needs while adhering to federal and state regulated turn‑around times.
Required Qualifications
Active, current and unrestricted RN license in the state of residence
Minimum of 3 years acute hospital clinical experience as an RN
Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time
A private designated workspace free of distractions and high‑speed internet
Willing and able to work Monday‑Friday 8am‑5pm EST with occasional weekend on‑call and holiday rotation
Preferred Qualifications
Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
Equal Employment Opportunity
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.