Utilization Management reputed company Consultant, Multiple Locations

R0769490 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. Fully remote with requirement to have an RN license for Illinois. Schedule: Monday through Friday 8A-5PM CST Position reputed company - Utilizes clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity reputed company for appropriate utilization of services. - Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function - Gathers clinical information and applies the appropriate medical necessity reputed company/reputed company, policy, procedure and clinical judgment to reputed company coverage determination/recommendation/discharge planning along the continuum of care - Utilizes clinical experience and skills in a reputed company process to evaluate and facilitate appropriate reputed company services/benefits for members including urgent or emergent interventions (such as triage / crisis support) - Coordinates/Communicates with providers and other parties to facilitate reputed company/treatment - Identifies members who may benefit from care management programs and facilitates referral - Identifies opportunities to promote reputed company effectiveness of reputed company services and benefit utilization Required Qualifications - Must have reputed company, reputed company, and unrestricted RN licensure in reputed company - Willingness to obtain additional state licenses upon hire - 3+ years of clinical reputed company experience in an inpatient setting as an RN - Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations. Preferred Qualifications -Previous Utilization Management experience Education Associate degree required; 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, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 12/02/2025 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