Utilization Management Nurse Consultant

Utilization Management Nurse Consultant (RN)

Remote | Full-Time

Utilization Management is a 24/7 operation. Work schedules may include weekends, holidays, and evening hours.

Are you a Registered Nurse looking to leverage your clinical expertise in a collaborative, non-bedside environment? Join our Utilization Management team and help ensure members receive appropriate, high-quality healthcare services through evidence-based clinical review and care coordination.

What You'll Do

• Review clinical information and apply established guidelines, policies, and clinical judgment to make coverage determinations and recommendations.
• Assess, plan, coordinate, and monitor healthcare services to support appropriate utilization and member outcomes.
• Collaborate with providers and care teams to facilitate treatment and care coordination.
• Identify opportunities for members to benefit from additional programs, services, and resources.
• Promote quality, effectiveness, and appropriate healthcare utilization.
• Serve as a clinical resource to internal and external stakeholders on utilization and benefit management matters.
• Manage multiple priorities in a fast-paced, technology-driven environment.

What You Bring - Required

• Active, current, and unrestricted RN license in the state of residence.
• 2+ years of experience as a Registered Nurse in an adult acute care or critical care setting.
• Strong clinical assessment, critical thinking, and communication skills.
• Proficiency navigating multiple computer systems and applications.
• Ability to work schedules that may include weekends, holidays, and evening hours.

Preferred Qualifications

• 2+ years of Med/Surg or specialty nursing experience.
• Managed Care experience, particularly in Utilization Management.
• BSN preferred.

Education

• Associate Degree in Nursing required.
• Bachelor of Science in Nursing (BSN) preferred.

Why Join Us?

• Transition your clinical expertise into a collaborative healthcare management role.
• Make a meaningful impact on member care and healthcare quality.
• Work remotely in a supportive, team-oriented environment.
• Develop expertise in utilization management, care coordination, and healthcare operations.

If you're passionate about improving healthcare outcomes while using your nursing expertise in a dynamic remote setting, we'd love to hear from you.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $32.01 - $68.55

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.