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CategoryHealthcare
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No of Jobs1
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Apply Before10/04/2025
Description
Utilization Management Nurse Consultant - Fully Remote
Lensa - Montgomery, AL
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Registered Nurse (RN)
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: Montgomery
State: AL
ZIP Code:
Job Responsibilities
- Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
- Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gather clinical information and apply appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products, services, and/or programs.
- Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Function in a clinical telephone queue working with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical judgment
- Utilization management
- Clinical assessment
- Effective communication skills
Preferred Skills
- Managed Care experience
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization, 5 years of clinical experience required.
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse license (unrestricted) with multi-state/compact privileges
Schedule:
- Monday-Friday: 8:30am-5:00pm (training for first 3 weeks required)
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- Wellness screenings
- Tobacco cessation programs
- Weight management programs
- Confidential counseling
- Financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Bonus eligibility
- Commission or short-term incentive program
Special Notes
- Diversity and inclusion commitment
- Equal opportunity and affirmative action employer
Facility Details
Name: Lensa
Description: A leading health solutions company dedicated to transforming health care.
Specialties:
- Medical management
- Utilization Management
- Disease Management
Mission: Build a world of health around every consumer.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/04/2025
Posted:
07/04/2025
