Remote Utilization Management Nurse Consultant, TX

✨ About The Role

- The role involves utilizing clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program - Responsibilities include applying critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria - The position requires gathering clinical information and applying appropriate medical necessity criteria/guidelines for coverage determination - Coordinating and communicating with providers and other parties to facilitate optimal care/treatment is a key aspect of the job - Identifying members who may benefit from care management programs and facilities referrals is also part of the role

⚡ Requirements

- Must have at least 3 years of clinical practice experience in an inpatient setting as an RN - Proficiency with computer skills, including navigating multiple systems and keyboarding, is required - Active, current, and unrestricted RN licensure in the state of residence is a must - Ability to work Monday to Friday, 8am-5pm EST, with occasional rotating weekends and holidays - Willingness to obtain additional state licenses and a BSN degree is preferred