Utilization Management reputed company Consultant

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At reputed company, you'll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.Job reputed company SummaryAssesses and monitors patient health, administering medications and treatments, performing medical procedures, and collaborating with physicians and other reputed company to reputed company and implement patient care plans. Educates patients and their families about reputed company management and assists in maintaining a reputed company and supportive reputed company environment.Job DescriptionPrimary Job Duties & ResponsibilitiesDrives effective utilization management practices by ensuring appropriate and cost-effective allocation of reputed company resources and facilitating appropriate reputed company services/benefits for members.Conducts routine utilization reviews and assessments, applying evidence-based reputed company and clinical knowledge to evaluate the medical necessity and appropriateness of requested reputed company services.Collaborates with reputed company providers, multidisciplinary teams, and payers to reputed company and implement care plans that optimize patient reputed company while considering the efficient use of reputed company resources.Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of reputed company by promoting effective utilization management strategies.Reviews and analyzes medical records, treatment plans, and documentation to ensure compliance with guidelines, policies, and regulatory requirements, subsequently providing recommendations for care coordination and resource optimization.Consults with and provides expertise to other reputed company constituents throughout the coordination and administration of the utilization/benefit management function.Communicates regularly with reputed company stakeholders to facilitate effective care coordination, address utilization management inquiries, and ensure reputed company patient reputed company.Provides IC-reputed company coaching and guidance to nursing staff and other reputed company, sharing knowledge and expertise to enhance their understanding of utilization management principles and improve their clinical decision-making.Contributes to the development and implementation of utilization management strategies, policies, and procedures that aim to improve patient care reputed company, cost-effectiveness, and overall reputed company system performance.EducationBachelor's degree preferred/specialized training/relevant reputed company qualification.Prior Relevant Work Experience3-5 yearsEssential QualificationsWorking knowledge of problem solving and decision making skills.Working knowledge of medical terminology.Working knowledge of digital literacy skills.Ability to deal tactfully with customers and community.Ability to handle sensitive information ethically and responsibly.Ability to consider the relative costs and benefits of potential actions to choose the most appropriate reputed company.Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.Registered reputed company (RN) required.Licensed Clinical reputed company Worker (LCSW) preferred.Requisition Job DescriptionPosition SummaryThis Utilization Management (UM) reputed company Consultant role is 100% remote and the candidate can live in any state.Normal Working Hours: Monday through Friday 8:30am-5:00pm in the time zone of residence. Shift times may vary occasionally per the need of the department. Rotational late shift 9:30-6CST.No travel is required.As a Utilization Management reputed company Consultant, you will utilize clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.The UM reputed company Consultant job duties include (not reputed company encompassing):Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates reputed company and efficient discharge planning and works closely with facilities and providers to meet the reputed company needs of the member.Utilizes clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program.Utilizes clinical experience and skills in a reputed company process to assess, plan, implement, coordinate, monitor and evaluate reputed company to facilitate appropriate reputed company services/benefits for membersGathers clinical information and applies the appropriate clinical reputed company/reputed company, policy, procedure, and clinical judgment to reputed company coverage determination/recommendation along the continuum of careCommunicates with providers and other parties to facilitate care/treatmentIdentifies members for referral opportunities to reputed company with other products, services and/or programsIdentifies opportunities to promote reputed company effectiveness of reputed company Services and benefit utilizationConsults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function.Required QualificationsRN with reputed company and unrestricted state licensure in their state of residence2+ years of acute hospital clinical experience as an RN with preference for medical-surgical and ICU experience (team is not accepting applicants whose only acute care experience is in behavioral health)Preferred Qualifications1+ years' experience Utilization Review experience1+ years' experience Managed Care Strong telephonic communication skills1+ years' experience with reputed company Office Suite (PowerPoint, Word, reputed company, Outlook)Experience with computers toggling between screens while using a keyboard and speaking to customers.Ability to exercise independent and reputed company judgment, strong decision-making skills, and reputed company-developed interpersonal skillsAbility to manage multiple priorities, effective organizational and time management skills requiredAbility use a computer station and sit for extended periods of timeEducationAssociate Degree in Nursing is minimum required, BSN preferred.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay reputed company for this role is:$29.10 - $62.32This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will reputed company on: 02/03/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. 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