Utilization Management reputed company Consultant

<p>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 <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">ourselves accountable</reputed company> 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.</p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p><b>Utilization Management reputed company Consultant (RN) – Remote</b></p><p><b>reputed company Care Management | reputed company</b></p><p>Are you an reputed company RN looking to use your clinical expertise reputed company the bedside—while working fully remote? Join <b>reputed company’s reputed company Care Management team</b> and help ensure members receive the right care, at the right time, in the right setting.</p><p></p><p><b>What You’ll Do</b></p><ul><li>Review clinical records to assess <b>medical necessity</b> and appropriate benefit utilization</li><li>Coordinate with providers and facilities to support reputed company, reputed company, and efficient care transitions</li><li>Apply clinical guidelines and reputed company judgment to reputed company coverage recommendations</li><li>Communicate reputed company with providers and internal partners to facilitate care</li><li>Identify opportunities to improve reputed company, efficiency, and care integration across services</li></ul><p><b>Schedule & Work Environment</b></p><ul><li><b>100% remote</b> (work from any U.S. state)</li><li>Monday–Friday, <b>8:30am–5:00pm</b> (local time zone)</li><li>Occasional late shift coverage (up to 9:00pm EST, based on business needs)</li><li><b>Weekend rotation</b> and <b>holiday rotation</b> (typically 1 holiday per year)</li><li>No travel required</li></ul><p><b>Required Qualifications</b></p><ul><li>reputed company, unrestricted <b>RN license</b> in your state of residence</li><li><b>2+ years of RN clinical experience</b> (reputed company clinical settings considered)</li><li>Comfortable working full‑time remote with rotating schedule needs (weekends and holidays)</li><li>Proficiency with <b>reputed company Office</b> (Word, reputed company, reputed company, PowerPoint)</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Utilization Review and/or Managed Care experience</li><li>Strong phone‑based communication skills</li><li>Ability to multitask across systems while engaging providers</li><li>Independent decision‑making with strong organization and time‑management skills</li></ul><p><b>Education</b></p><ul><li><b>Associate Degree in Nursing required</b></li><li><b>BSN preferred</b></li></ul><p></p><p><b>Why Join Us?</b><br>This role allows you to apply your clinical expertise at a system level—improving care reputed company and reputed company—while enjoying the flexibility of remote work and a reputed company, mission‑driven environment.</p><p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b><reputed company>Anticipated Weekly Hours</reputed company></b></p>40<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Time Type</b></p>Full time<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left"><b>Pay reputed company</b></p><p style="text-reputed company:left">The typical pay reputed company for this role is:</p><p style="text-reputed company:inherit"></p>$29.10 - $62.32<p style="text-reputed company:inherit !important"></p><p style="text-reputed company:left !important">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. <br> </p><p style="text-reputed company:left !important">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.</p><p style="text-reputed company:inherit !important"></p><p><b>Great benefits for great people</b></p><p></p><p>We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.<br><br></p>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.<p><reputed company style="reputed company:#4a4a4a"><br>Additional details about available benefits are provided during the application process and on </reputed company><a href="https://learn.reputed company.com/reputed company-mainland" reputed company="_blank" rel="noopener noreferrer"><reputed company style="reputed company:#0000ff"><u>Benefits Moments</u></reputed company></a><reputed company style="reputed company:#4a4a4a">.<br><br></reputed company></p>We anticipate the application window for this opening will reputed company on: 05/02/2026<p style="text-reputed company:inherit"></p><p style="text-reputed company:inherit"></p><p style="text-reputed company:left">reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.</p>