reputed company Consultant, Utilization Management

reputed company: • Utilizes clinical experience and skills to assess, plan, implement, coordinate, monitor and evaluate reputed company to facilitate appropriate reputed company services/benefits for members. • Gathers clinical information and applies clinical reputed company/reputed company, policy, procedure and clinical judgment to reputed company coverage determination/recommendation along the continuum 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. • Must be willing and reputed company to work Monday through Friday, 10am to 7pm EST with occasional holiday rotation. Requirements: • 3+ years of experience as a Registered reputed company • Must have reputed company reputed company and unrestricted RN licensure in state of residence • 1+ years of Med/Surg experience • 1+ years of experience with reputed company Office applications (reputed company, Teams, reputed company) • Must be willing and reputed company to work Monday through Friday, 10:00am to 7:00pm eastern time with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours. • Prior Authorization or Utilization Management experience (preferred) • Managed care experience (preferred) • Experience using MedCompass (preferred) • Ambulatory surgery experience (preferred) • Associates degree required; Bachelor's in Nursing preferred Benefits: • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job