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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 - Remote Work
The Muse - Indianapolis, IN
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Utilization/Benefit Management Nurse
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm 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.
- Collaboratively assess, plan, implement, coordinate, monitor and evaluate healthcare services/benefits for members.
- Gather clinical information and apply clinical criteria/guidelines to render coverage determinations.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities and promote quality effectiveness of healthcare services.
- Consult and lend expertise to internal and external constituents in utilization/benefit management.
- Function in a clinical telephone queue to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical judgment
- Utilization Management
- Prior authorization
- Proficient use of equipment
- Clinical documentation systems
Preferred Skills
- Managed Care experience
- Experience in high volume clinical call center
- Remote work experience
Requirements
Experience: 1 year in UM, concurrent review or prior authorization; 5 years of clinical experience; 5 years of independent clinical judgment;
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse license in state of residence with multi-state/compact privileges
Schedule:
- Training for first 3 weeks on-camera, 100% participation required 8:30am-5pm Monday-Friday.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost wellness programs
- Confidential counseling
- Financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for bonuses, commissions, or short-term incentives
Special Notes
- Commitment to creating a diverse and inclusive workplace where every colleague feels valued.
Facility Details
Name: The Muse
Description: Leading health solutions company reaching millions of Americans.
Specialties:
- Medical Management
- Healthcare
Mission: Transforming healthcare to become more connected, convenient and compassionate.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
