Registered Nurse Consultant

Job Summary

A company is looking for a Utilization Management Nurse Consultant (Remote).

Key Responsibilities

• Evaluate outpatient services requiring precertification using clinical judgment and evidence-based criteria
• Conduct clinical reviews and collaborate with healthcare providers to gather necessary information
• Authorize services based on established guidelines or escalate cases to Medical Directors as needed

Required Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence
• Minimum 5 years of relevant nursing experience
• Minimum 3 years of clinical experience in acute care or skilled nursing facility
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Commitment to attend mandatory 3-week training with 100% participation