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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 - Montgomery, AL
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Clinical Management
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 aspects of the utilization/benefit management program.
- Assess, plan, implement, coordinate, monitor, and evaluate options for appropriate healthcare services/benefits.
- Gather clinical information and apply clinical criteria and guidelines for coverage determination.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products and services.
- Promote quality effectiveness of healthcare services and benefit utilization.
- Consult with internal and external constituents on utilization/benefit management coordination.
- Function in a clinical telephone queue working with providers for prior authorization reviews.
Required Skills
Core Skills
- Clinical judgment
- Prior authorization experience
- Knowledge of healthcare services
- Proficient use of communication and clinical documentation systems
Preferred Skills
- Experience in Managed Care (MCO)
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year in 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 with multi-state/compact privileges.
Schedule:
- Required to attend the first 3 weeks on camera training 100% participation.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company contributions
- Employee stock purchase plan
- Wellness screenings, tobacco cessation, and weight management programs
- Confidential counseling and financial coaching
- Paid time off and flexible work schedules
- Family leave and dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for a CVS Health bonus, commission or short-term incentive program.
Special Notes
- Commits to fostering a workplace where every colleague feels valued.
Facility Details
Name: The Muse
Description: A leading health solutions company offering services to millions through a local presence and digital channels.
Specialties:
- Medical Management
- Utilization Management
- Healthcare Solutions
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
