Utilization Management Nurse Consultant - Medical Review (Remote)

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. As a Utilization Management Nurse Consultant specializing in Medical Review, you'll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers.

Requirements

• Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases.
• Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client.
• Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines.
• Must be able to work independently without personal distractions to meet quality and metric expectations.
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources