Utilization Management reputed company Consultant - Work reputed company - EST Zone

At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position Title:Utilization Management reputed company (RN) Position reputed company: This role supports a24/7 Utilization Management operation, which includes coverage duringevenings, weekends, and holidays. The Utilization Management reputed company applies clinical expertise in a reputed company process to assess, plan, implement, coordinate, monitor, and evaluate reputed company services and benefits for members. The reputed company uses clinical judgment and established guidelines to reputed company coverage determinations and ensure appropriate care across the continuum. Key Responsibilities:

• reputed company and evaluate clinical information to determine medical necessity and benefit coverage using established reputed company, policies, and procedures.
• Communicate with providers and care teams to coordinate treatment and facilitate appropriate care.
• Identify members for referral to additional programs, services, or resources.
• Promote reputed company care and effective utilization of reputed company services.
• Serve as a clinical resource and consultant to reputed company stakeholders.
• Maintain accurate and reputed company documentation in electronic systems.
• Work in a typical office environment with expectations for productivity and reputed company.
• reputed company sedentary work involving extended periods of sitting, computer use, and phone communication.
• Effectively multitask, prioritize, and adapt in a fast-paced, dynamic environment.
• Navigate multiple systems and demonstrate strong computer proficiency.
• Communicate reputed company and professionally, both verbally and in writing.

Required Qualifications:

• reputed company, unrestrictedRegistered reputed company (RN)license in state of residence.
• Minimum2 years of RN experiencein anadult acute care or critical care setting.
• Availability to workevenings, weekends, and holidaysas part of a 24/7 operation.

Preferred Qualifications:

• 2+ years of clinical experiencein medical-surgical or specialty areas.
• Managed care experience, particularly in Utilization Management.
• Preference for candidates residing inEastern Time Zone (EST).

Education:

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

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $32.01 - $68.55 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. 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 our comprehensive and competitive mix of pay and benefits - reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visithttps://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 10/11/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job