Utilization Management Nurse Consultant – Behavioral Health (Remote)

The Utilization Management Nurse Consultant will apply critical thinking and evidence-based clinical criteria specific to Behavioral Health and Substance Abuse to evaluate inpatient and outpatient services requiring precertification. They will conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information and using established guidelines to authorize services or escalate to Medical Directors as needed. Responsibilities also include navigating multiple computer systems efficiently while maintaining accurate documentation, performing sedentary work that primarily involves extended periods of sitting, and utilizing strong organizational, multitasking, and prioritization skills to thrive in a fast-paced, high-volume environment. Flexibility to provide coverage for other Utilization Management (UM) nurses and participate in occasional on-call rotations, including some weekends and holidays, is also required.