Utilization Management Nurse Consultant - Florida

Position Summary Utilization Management Nurse Consultant – A 24/7 operation based in Florida. This role works from home and requires the applicant to reside in Florida. Responsibilities Coordinate, document and communicate all aspects of the utilization/benefit management program. Apply critical thinking and knowledge of evidence-based care and medical necessity criteria for appropriate utilization of services. Consult and lend expertise to internal and external constituents in the coordination and administration of utilization/benefit management. Gather clinical information and apply appropriate medical necessity criteria, guideline, policy, procedure and clinical judgment to render coverage determination, recommendation and discharge planning. Utilize clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services and benefits for members, including urgent or emergent interventions such as triage or crisis support. Coordinate and communicate with providers and other parties to facilitate optimal care and treatment. Identify members who may benefit from care management programs and facilitate referral. Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. Required Qualifications 3+ years of clinical practice experience in an inpatient setting. Active, current and unrestricted RN licensure in the state of Florida. Willingness to obtain additional state licenses as needed (paid for by company). Must reside in Florida. Preferred Qualifications Previous utilization management and/or managed care experience. Discharge planning experience. Education Associate’s degree required. BSN preferred. Compensation & Benefits Typical pay range: $29.10 – $62.32 per hour. The position is eligible for additional incentive programs. Benefits include medical, dental, vision coverage, paid time off, retirement savings options, wellness programs and other resources. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators