Utilization Management Nurse Consultant – Specialty Medications
Job Description:
- Apply clinical judgment and evidence-based criteria to review inpatient and outpatient services.
- Collaborate with providers and authorize care while maintaining accurate documentation.
- Participate in occasional on-call rotations, including some weekends and holidays.
- Conduct clinical reviews via phone and collaborate with healthcare providers to gather necessary information.
- Navigate multiple computer systems efficiently while maintaining documentation accuracy.
- Flexibly provide coverage for other Utilization Management Nurses as needed.
Requirements:
- Active unrestricted state Registered Nurse licensure in state of residence required.
- 1+ year of prior authorization of injectable/infused specialty medication experience.
- Minimum 5 years of relevant experience in Nursing.
- At least 1 year of Utilization Management experience in concurrent review or prior authorization.
- Strong decision-making skills and clinical judgment in independent scenarios.
- Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.
- Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.
Benefits:
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
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