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. Apply Job!