UM Nurse Consultant (RN in KY) - Remote Eligible

✨ About The Role

- The position involves utilizing clinical skills to coordinate, document, and communicate aspects of the utilization and benefit management program. - The candidate will gather clinical information and apply medical criteria along with relevant guidelines to render coverage determinations. - The role includes coaching and training junior colleagues in techniques and responsibilities related to utilization management. - The candidate will identify members who may benefit from comprehensive care management programs and facilitate referrals based on their needs. - After training, the candidate will be on call for one weekend every three months, with additional compensation for those hours.

⚡ Requirements

- The ideal candidate will have an active, current, and unrestricted RN licensure in the state of Kentucky. - A minimum of 3 years of clinical practice experience in an inpatient setting as a registered nurse is required. - Experience in managed care, discharge planning, and utilization management is preferred. - The candidate should possess strong critical thinking skills and be knowledgeable in evidence-based care and clinical practice guidelines. - The role requires effective communication and coordination with medical providers and third parties to ensure optimal care for customers.