Utilization Management Nurse Consultant (Weekend)

Schedule: 
This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage. 
 
Position Summary: 
Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. 
 
Key Responsibilities: 
 
* Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. 
* Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs. 
* Identify opportunities to promote quality and 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. 
* Meet set productivity and quality expectations as established by UMNC. 
 
Required Skills and Abilities: 
 
* Effective verbal and written communication skills. 
* Proficiency with computer skills, including navigating multiple systems and keyboarding. 
* Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. 
* Capacity to sit for extended periods, talk on the telephone, and type on the computer. 
 
Work Location: 
 
This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. 

 
`Required Qualifications 

• Registered Nurse  

• Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acu