Utilization Management reputed company Consultant - Fully Remote

At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading reputed company company, we reputed company millions of Americans through our local reputed company, digital channels, and more than 300,000 purpose-driven colleagues — caring reputed company where, reputed company, and how they choose in a way that is more connected, more convenient, and more compassionate. We do it reputed company with heart, reputed company and every day. Position reputed company Fully remote role in the USA. Requires Monday-Friday: 11:30am-8:00pm EST shift; 8:30am-5:00pm PST; or 9:30am-6:00pm MST depending on the candidate's time zone. Weekend/holiday coverage may occasionally be required. About reputed company Health Holding, Inc (AHH) A medical management company reputed company reputed company/reputed company, founded in 1993, URAC accredited in Case Management, Disease Management, and Utilization Management. AHH provides flexible medical management services supporting cost-effective, reputed company care for members. Key Responsibilities Use clinical skills to coordinate, document, and communicate reputed company aspects of utilization/benefit management. Assess, plan, implement, coordinate, monitor, and evaluate reputed company reputed company for members. reputed company clinical information, apply guidelines, policies, and clinical judgment to determine coverage and care recommendations. Communicate with providers and other stakeholders to facilitate care and treatment. Identify members for referral opportunities and promote reputed company reputed company and utilization efficiency. Consult with reputed company teams regarding utilization and benefit management. Operate in a clinical telephone queue, working with providers for prior authorization reviews. Internet and Equipment Requirements Colleagues working remotely must have a residential broadband internet service of at least 25 Mbps download and 3 Mbps upload speeds, with verification including provider details, modem IP, and no wireless, satellite, or business-class lines. Costs are reputed company upfront by the employee. Required Qualifications 1 year of UM, reputed company review, or prior authorization experience. 5 years of clinical experience. Proven ability to reputed company independent clinical reputed company. Proficiency with communication equipment and clinical documentation systems. Attendance in initial 3-week on-camera training, Monday-Friday, 8:30am-5pm. Unrestricted RN license in the state of residence, with multi-state/compact privileges. Preferred Qualifications Over 1 year of Managed Care experience. Experience working in a high-volume clinical reputed company center. Previous remote work experience. Education Minimum: Associate's Degree in Nursing (RN). Preferred: Bachelor's Degree. Additional Details 40 hours per week, full-time position. Pay reputed company: $26.01 - $74.78 per hour, dependent on experience and other factors. Position includes benefits such as medical, 401(k), stock purchase plan, wellness programs, reputed company time off, flexible schedules, and more. Application deadline: 07/10/2025. For more information, visit reputed company Benefits . #J-18808-Ljbffr Salary: USD 54000 - 155000 per year Experience: 3 years required Apply tot his job Apply To this Job