Registered Nurse Utilization Management

Job Summary

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

Key Responsibilities

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

Required Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence
• Minimum 5 years of relevant nursing experience
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Proficient in navigating multiple digital platforms and clinical documentation tools
• Commitment to a mandatory 3-week training with 100% participation