Utilization Management Nurse Consultant

Position Summary 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. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written. Required Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. Current and unrestricted RN licensure in state of residence. Work schedules will include weekends, holidays, and evening hours (24/7 operation). Preferred Qualifications 2+ years of clinical experience in med surg or specialty area. Managed Care experience preferred, especially Utilization Management. Preference for those residing in EST zones. Education Associates Degree required. BSN preferred. Work Hours 40 hours per week. Full time. 24/7 operation includes weekends, holidays, and evening hours. Compensation Pay range: $26.01 - $68.55 per hour (base). Eligible for bonus, commission, or short-term incentive program. Benefits Eligibility for comprehensive benefits package, including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and additional resources. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr