Utilization Management Nurse Consultant - Weekends S/S/M/T (4-10 hour shifts)

Position Summary

Medicare Predetermination Utilization Management Nurse Consultant position

Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours

• 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.

Required Qualifications

• 3+ years of experience as a Registered Nurse
• Must have active current and unrestricted RN licensure in state of residence
• 1+ years of Med/Surg experience
• 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel)
• Must be willing and able to work Saturday, Sunday, Monday and Tuesday 10 hr shifts after approx 4-5 months of training Monday - Friday 7:30am-6pm EST with occasional holiday rotation.

Preferred Qualifications

• Prior Authorization or Utilization Management experience
• Managed care experience
• Experience using MedCompass
• Ambulatory surgery experience
• Medicare experience is a must

Education

Associates degree required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is

$26.01 - $68.55