Utilization Management Nurse Consultant (Work From Home)

Utilization Management Nurse Consultant Clinical Precertification RN

Remote | Full-Time | Weekday Schedule

Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time.

What You'll Do

• Review clinical cases and make coverage determinations using evidence-based guidelines
• Collaborate with providers, attending MDs and care teams to complete precertification requests
• Apply clinical judgment to support utilization and benefit management decisions
• Identify opportunities to improve care quality and member outcomes
• Serve as a clinical resource across internal and external stakeholders

What You Bring - REQUIRED

• Active, unrestricted RN license in the state of residence.
• 2+ years of RN experience, including 1+ year in Med/Surg
• Strong clinical assessment and decision-making skills
• Experience with Microsoft Office (Outlook, Teams, Excel)
• Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours
• Associate Degree in Nursing

Preferred Qualifications

• Utilization Management or Prior Authorization experience
• Managed care background
• Ambulatory surgery background
• BSN preferred

If you're passionate about combining clinical expertise with care coordination and healthcare quality, we'd love to hear from you!

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is

$26.01 - $56.14