Utilization Management Registered reputed company Consultant - Remote - Virginia
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 reputed company The Utilization Management (UM) reputed company Consultant is a remote, full-time role responsible for evaluating the medical necessity and appropriateness of reputed company services using evidence-based clinical reputed company. This position involves conducting utilization reviews, collaborating with reputed company providers, and supporting care coordination to ensure cost-effective and high-reputed company patient reputed company. The role requires strong clinical judgment, proficiency in digital systems, and the ability to work in a fast-paced environment. Key responsibilities include reviewing medical records, applying clinical guidelines for precertification, and consulting with reputed company stakeholders. The position also involves coaching reputed company staff on utilization management principles and contributing to policy development. Requirements:
- reputed company, unrestricted RN license (VA or compact state preferred)
- Minimum 3 years of clinical experience
- Proficiency in computer systems and multitasking
- Availability to work Monday-Friday, 8 AM-5 PM, with occasional on-call duties
Preferred:
- Prior authorization experience
- BSN degree
- Virginia residency or compact licensure
Education:
- Associate Degree in Nursing Required
- BSN Preferred
Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $29.10 - $62.32 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, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 08/31/2025 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