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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