This Utilization Management Nurse Consultant (UMNC) position is a work at home position (fully remote) and the candidate can live in any state.
Normal Working Hours: Monday through Friday 8:00am-6:00pm in the time zone of residence with an evening rotation per the needs of the team.
In addition, the team is open to candidates in PST and/or MST time zones to provide increased daily coverage until 6:30pm EST (10:00am-6:30pm EST).
There is a weekend (Saturday and Sunday both) and holiday rotation per the needs of the department.
Minimal travel is expected but could be up to 10% in the event of a clinical audit.
As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all 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. Looking for someone who is high energy and motivated team environment and is detail oriented and highly organized.
The UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
Required Qualifications
- Must have an active and unrestricted RN license in the state of residence
- Willing and able to obtain a CA state RN license within 6 months of hire (company paid)
- 2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years)
Preferred Qualifications
- Compact RN license or the ability to obtain a compact license
- Utilization Review experience
- Managed Care background
- Strong telephonic communication skills
- Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Education
- Minimum Associates Degree in Nursing
- BSN preferred