Utilization Management Nurse Consultant - Remote

The Utilization Management Nurse Consultant will apply critical thinking and evidence-based clinical criteria to evaluate services requiring precertification, conducting clinical reviews via phone and electronic documentation. They will collaborate with healthcare providers to gather necessary information, use established guidelines to authorize services or escalate to Medical Directors, and navigate multiple computer systems efficiently while maintaining accurate documentation. The role requires thriving in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills, performing sedentary work that primarily involves extended periods of sitting. Flexibility to provide coverage for other UM Nurses across various UM specialty teams and participate in occasional on-call rotations, including some weekends and holidays, is expected.