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CategoryHealthcare
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No of Jobs1
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Apply Before10/01/2025
Description
Utilization Management Nurse Consultant - Fully Remote
The Muse - Indianapolis, IN
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Registered Nurse
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday, 11:30am-8:00pm EST; 8:30am-5:00pm PST; 9:30am-6:00pm MST
Work Type: Remote
Location
Address:
City: Indianapolis
State: IN
ZIP Code:
Job Responsibilities
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determinations/recommendations along the continuum of care.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services and/or programs.
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Functions in a clinical telephone queue working with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- 1 year of utilization management experience
- 5 years of clinical experience
- Demonstrated ability to make thorough independent decisions using clinical judgment
- Proficient use of medical equipment including phone and computer
- Experience with clinical documentation systems
Preferred Skills
- 1+ years of Managed Care experience
- 1+ years of experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year of UM, 5 years of clinical experience
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred
License & Certification:
- Unrestricted RN license in state of residence with multi-state/compact privileges
Schedule:
- Weekend/holiday coverage will occasionally be required
- Training requires 100% participation during the first 3 weeks, 8:30am-5pm Monday-Friday
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- Wellness screenings and programs
- Confidential counseling and financial coaching
- Flexible work schedules
- Paid time off
- Tuition assistance
- Dependent care resources
Supplemental Pay
- Eligible for bonuses, commissions, or short-term incentive programs
Special Notes
- Commitment to fostering a workplace where every colleague feels valued and that they belong.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Facility Details
Name: The Muse
Description: Leading health solutions company caring for people with innovative and compassionate services.
Specialties:
- Healthcare
- Medical Management
- Utilization Management
Mission: Building a world of health around every consumer.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
