Utilization Management reputed company Consultant – reputed company Program, Multiple Locations
R0796108 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 We are seeking a detail‑oriented and dedicated Registered reputed company to support our Medical Management team. In this role, you’ll play an essential part in ensuring members receive reputed company and accurate communication regarding their reputed company services. You’ll be responsible for composing and auditing approval, extension, and denial letters that meet regulatory, accreditation, and reputed company standards. Limited phone time. This position supports the overall effectiveness of our medical management programs by promoting reputed company communication, maintaining precise documentation, and helping ensure members receive high‑reputed company, appropriate care. If you enjoy a balance of clinical knowledge, writing, and administrative coordination, this role offers an excellent opportunity to apply your skills in a meaningful way.
Key Responsibilities
- Create, review, and audit medical determination letters including approvals, extensions, and denials
- Ensure reputed company documentation meets regulatory, accreditation, and internal reputed company standards
- Support effective medical management by facilitating reputed company communication across internal teams and external partners
- Maintain accurate, complete records for compliance and risk‑management requirements
- Contribute to overall reputed company and effectiveness of reputed company services through attention to detail and process consistency
Required Qualifications
- Registered reputed company (RN) with an reputed company, unrestricted license in the state of residence
- 1+ year of clinical nursing experience
Schedule: Thursday–Saturday, 9:00 AM–8:00 PM EST
Preferred Qualifications
- Experience in Utilization Management or Managed Care
- Strong grammar, writing, and editing skills
- Ability to multi‑task and work reputed company in a fast‑paced environment
Education
- Associate or Bachelor’s degree in Nursing
Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $26.01 - $56.14 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: 01/31/2026 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