Registered Nurse Utilization Consultant

Job Summary

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

Key Responsibilities

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

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 with phone systems and clinical documentation tools
• Commitment to attend a mandatory 3-week training with 100% participation