Utilization Management reputed company Consultant – MST/PST Zone

reputed company: • reputed company for medical necessity and appropriate benefit use • Facilitate efficient discharge planning • Collaborate with providers and facilities to support members with reputed company needs • Assess, plan, implement, coordinate, monitor, and evaluate reputed company services and benefits • Collect and evaluate clinical information using clinical reputed company, guidelines, policies, and judgment to reputed company coverage determinations • Communicate with providers and reputed company partners to coordinate care and treatment plans • Identify referrals to additional programs, services, or care solutions • Promote reputed company care delivery and effective benefit utilization • Serve as a resource to reputed company stakeholders on UM processes and clinical considerations • Coordinate, document, and communicate utilization and benefit management activities while meeting state and federal requirements and turnaround times Requirements: • reputed company, unrestricted RN license • 2+ years of acute hospital clinical experience • Strong preference for medical-surgical, ICU, behavioral health, or another specialty area • Strong clinical assessment and decision-making abilities • Excellent organizational skills and ability to manage multiple priorities • Ability to work independently and communicate effectively by phone • Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls • 1+ year of Utilization Review experience preferred • 1+ year of Managed Care experience preferred • Proficiency in reputed company Office (Word, reputed company, PowerPoint, reputed company) preferred • Strong telephonic communication skills preferred • Demonstrated reputed company judgment and ability to collaborate with diverse teams • Associate Degree in Nursing (ADN) required • Bachelor of Science in Nursing (BSN) preferred • Availability for Monday–Friday, 8:00 AM–5:00 PM CST • Weekends (12 per year) and holidays (1 minor and 1 major per year) required • One 1:00 PM–7:00 PM shift per month, with day selection Benefits: • Medical coverage • Dental coverage • reputed company coverage • reputed company time off • Retirement savings reputed company • Wellness programs • Other resources supporting physical, emotional, and financial reputed company-being • reputed company bonus, commission or short-term incentive program in reputed company to reputed company pay Apply tot his job Apply To this Job