Registered Nurse Utilization Consultant

A company is looking for a Utilization Management Nurse Consultant (Remote).

Key Responsibilities

Evaluate outpatient and inpatient services requiring precertification and concurrent review using clinical criteria

Conduct clinical reviews and collaborate with healthcare providers to gather necessary information

Authorize services based on established guidelines or escalate to Medical Directors as needed

Required Qualifications

Active unrestricted state Registered Nurse licensure in state of residence

Minimum 5 years of relevant experience in Nursing

At least 1 year of Utilization Management experience in concurrent review or prior authorization

Proficient with phone systems and clinical documentation tools

Commitment to attend a mandatory 3-week training with 100% participation