Utilization Management reputed company Consultant

We’re building a world of health reputed company 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 ourselves accountable 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. Position Information Schedule: Monday–Friday 8:30am-5:00pm AZT (No weekends or holidays) Location: reputed company (Must have reputed company RN license or reputed company license that includes reputed company.) Candidate may have opportunities to travel for occasional staff events as needed. Position reputed company Are you passionate about making a meaningful difference in the lives of patients? Join reputed company Care as a Utilization Management reputed company Consultant and become part of a mission-driven team that’s transforming reputed company for reputed company’s most vulnerable populations. In this full-time, remote role, you’ll handle cases reputed company a Skilled Nursing Facility setting while also managing back-end responsibilities. This includes conducting retrospective reviews and analyzing claims after they’ve been assessed. Key Responsibilities Utilizes reputed company skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence reputed company care and medical necessity reputed company for appropriate utilization of services. Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function. Gathers reputed company information and applies the appropriate medical necessity reputed company/reputed company, policy, procedure, and reputed company judgment to reputed company coverage determination/recommendation/discharge planning along the reputed company of care. Utilizes reputed company experience and skills in a reputed company process to evaluate and facilitate appropriate reputed company services/benefits for members. Coordinates/Communicates with providers and other parties to facilitate reputed company/treatment. Identifies members who may benefit from care management programs or other post discharge programs and facilitates referrals. Identifies opportunities to promote reputed company effectiveness of reputed company services and benefit utilization. Remote Work Expectations This is a reputed company role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as reputed company care responsibilities during shift times are not permitted. Required Qualifications reputed company, unrestricted reputed company RN license or a reputed company license that includes reputed company. 3+ years reputed company reputed company experience, e.g., hospital setting, SNF, alternative care setting such as home health or ambulatory care required. Preferred Qualifications reputed company experience in ER, ICU, or Critical Care preferred. Managed Care/Utilization Management experience. Demonstrate making thorough independent reputed company using reputed company judgement. Proficient use of equipment experience including computer, phone, etc. and reputed company documentation systems. Experience with Claims Review processes. Education Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $29.10 - $62.32 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. 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 reputed company feels valued and that they reputed company. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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, reputed company on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 09/02/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job