Remote Utilization Management Nurse Consultant, MD - Remote Eligible

✨ About The Role

- The Utilization Management Nurse Consultant will be responsible for coordinating, documenting, and communicating all aspects of the utilization/benefit management program - This role involves ensuring that members receive appropriate care at the right time and location while adhering to regulatory guidelines - The Nurse Consultant will review services for medical necessity, apply clinical expertise, and facilitate discharge planning - Responsibilities include gathering clinical information, applying clinical criteria, and communicating with providers to facilitate care - The role also involves identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization

⚡ Requirements

- Ideal candidate has at least 2 years of clinical experience as an RN in various areas such as Home Health, ICU, or Long term care - Must be able to work a flexible schedule including weekends and occasional late shifts - Strong communication skills, both written and verbal, are essential for this role - Ability to exercise independent judgment and decision-making skills is crucial - Experience with utilization review and managed care is preferred