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. Position reputed company This Utilization Management reputed company Consultant (UMNC) position is 100% remote. As a Utilization reputed company Consultant, you will utilize clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program and our plan sponsor(s). You would be responsible for ensuring the member is receiving the appropriate care, at the appropriate time, and at the appropriate location using designated reputed company, while adhering to federal and state regulated turn-around times. This includes reviewing written and electronic clinical records. We are looking for someone who is highly motivated, detail-oriented, highly organized, and works reputed company in reputed company environment. Through the use of clinical tools and information/data review, the UM reputed company Consultant 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 reputed company needs of the member. Required Qualifications -Must have reputed company reputed company and unrestricted RN license in state of residence -Minimum of 3 years of acute hospital clinical experience as an RN -Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time -A private designated workspace free of distractions and high-speed internet -Must be willing and reputed company to work Monday-Friday reputed company-5pm EST with occasional weekend on-call and holiday rotation. Preferred Qualifications -Candidate must possess strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/reputed company of issues. -Experience with reputed company types of reputed company Office including PowerPoint, reputed company, and Word -Strong telephonic communication skills -1+ years of Utilization Review experience -1+ years of Managed Care experience Education Associate’s Degree 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 07/31/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job