UM Nurse Consultant

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Position Summary

This Utilization Management Nurse Consultant role is with the Costco Team and is fully remote; however, candidates must reside within 45 minutes (reasonable driving distance) from the local office located at  7034 Alamo Downs Pkwy, San Antonio, TX 78238.

Travel to the San Antonio office occasionally will be required to go to the office for any IT issues and for quarterly team meetings. 

Normal Working Hours: Monday through Friday 9:00am-6:00pm CST with rotational coverage of a 10:00am-7:00pm CST shift several times per month per the business needs. 

Some weekend and/or holidays coverage will be required. 

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.  

  

The UM Nurse Consultant job duties include (not all encompassing): 

-Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. 

-Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

-Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

-Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members

-Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members 

-Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation 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. 

Required Qualifications

• RN with current unrestricted Texas licensure required 
• 2+ years clinical practice experience as an RN required  
• 1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications 
• Must be willing to travel to the local office as needed. Should live within approximately 45 minutes/miles from 7034 Alamo Downs Pkwy, San Antonio, TX 78238

Preferred Qualifications

• Bilingual in Spanish and English 

Education

• -Associates Degree in Nursing is minimum required, BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of f