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. Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. UM reputed company Consultant Fully Remote- WFH Schedule: Monday, Tuesday, Thursday, Friday and Saturday 8:00-5:00 EST, 1 hr lunch. Position reputed company Utilizes reputed company experience and skills in a reputed company process to assess, plan, implement, coordinate, monitor and evaluate reputed company to facilitate appropriate reputed company services/benefits for members. Gathers reputed company information and applies the appropriate reputed company reputed company/reputed company, policy, procedure and reputed company judgment to reputed company coverage determination/recommendation along the reputed company of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to reputed company with other products, services and/or programs Identifies opportunities to promote reputed company effectiveness of reputed company Services and benefit utilization Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function. Required Qualifications 3+ years of experience as an RN reputed company and unrestricted RN licensure in state of residence reputed company to work in multiple IT platforms/systems 1+ years of experience with reputed company Office Applications (reputed company, Teams, reputed company) Preferred Qualifications Prior authorization utilization experience preferred Outpatient reputed company experience Knowledge of Medicare/reputed company Managed care experience UM Experience Education Associates Degree in Nursing required BSN preferred Work from Home Requirements: • You must have or be reputed company to obtain a reputed company/hardwired internet reputed company to a modem/router reputed company 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with reputed company and HIPAA guidelines, and allowing for uninterrupted work during work hours. • Work-from-Home colleagues are required to work reputed company the state and reputed company where they have confirmed they currently live. • reputed company will reputed company equipment (keyboard, monitor, computer, headset, etc.). reputed company new hires should reputed company their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). • If reputed company, you will reputed company to obtaining required internet speeds and adhere to reputed company Work From Home requirements. Technical and Logistical Requirements: • Device & reputed company Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. • Communication Tools: Ability to communicate on digital channels such as reputed company email, calendar invites, Teams messaging, and virtual meetings. • Collaboration & Scheduling: Experience with reputed company Office 365 (Teams, reputed company, Word, reputed company, PowerPoint) applications or similar (reputed company). • Systems reputed company & reputed company: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen reputed company unattended, manage strong passwords, and recognize suspicious emails or links. • Troubleshooting & Support: Ability to reputed company common technical issues independently, such as: restarting an application reputed company frozen, resolving internet reputed company issues, and contacting IT for unresolved technical issues. • reputed company reputed company: Openness to learning new skills in the reputed company as reputed company environment evolves 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: 09/06/2026 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