UM Nurse Consultant Afternoon Shift | (Remote) Id-2284

Position Summary

100% remote position from anywhere in the U.S. Work hours: 11:30am-8:00pm eastern time shift for at least first 9 months post completion of orientation period.

Required to attend the first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday.

Work in clinical telephone queue working with providers to secure additional information for prior authorization review

-Weekend/holiday coverage will occasionally be required

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-This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

-Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members

-Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render determination/recommendation along the continuum of care

-Communicates with providers and other parties to facilitate care/treatment

– Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

– Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

 

Required Qualifications

1 year UM, concurrent review or prior authorization

5 years of clinical experience required

5 years Demonstrated to make thorough independent decisions using clinical judgement

Required to attend the first 3 weeks training required 100% participation during 8:30am-5pm Monday-Friday.

A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all noncompact states.

 

Preferred Qualifications

1+ years Managed Care (MCO) preferred

1+ years demonstrated experience working in a high volume clinical call center environment

Remote work experience

 

Education

Associate degree in nursing RN required.

BSN preferred. 

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