Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 6 hours ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Lifelancer

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2020

💼 Consulting

🏥 Healthcare

📦 Logistics

💰 Pre Seed Round on 2022-03

Consulting • Healthcare • Logistics

Lifelancer is an AI-powered talent hiring platform that connects employers with skilled professionals in the Life Sciences, Pharmaceutical, and IT sectors. It enables individuals to create profiles showcasing their skills, get matched with high-paying international jobs or projects, and facilitates hiring and payroll for employers in multiple countries. The platform aims to streamline the hiring process with efficient AI sourcing and compliance support.

📋 Description

• Coordinate, document, and communicate all aspects of the utilization/benefit management program • Apply critical thinking, evidence-based care, and medical necessity criteria to determine appropriate utilization of services • Consult with internal and external constituents regarding utilization/benefit management • Gather clinical information and apply medical necessity criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations, recommendations, and discharge planning • Evaluate and facilitate appropriate healthcare services and benefits for members • Coordinate and communicate with providers and other parties to facilitate optimal care and treatment • Identify members who may benefit from care management or post-discharge programs and facilitate referrals • Identify opportunities to promote quality and effective healthcare services and benefit utilization • Handle cases in a Skilled Nursing Facility setting • Conduct retrospective reviews and analyze assessed claims

🎯 Requirements

• Active, unrestricted Arizona RN license or a compact license that includes Arizona • 3+ years clinical practice experience, e.g., hospital setting, SNF, home health, or ambulatory care • Associate's degree in nursing (RN) required • Clinical experience in ER, ICU, or Critical Care preferred • Managed Care/Utilization Management experience preferred • Ability to make thorough independent decisions using clinical judgment • Proficient use of computer, phone, equipment, and clinical documentation systems • Experience with claims review processes • Dedicated workspace free of interruptions • Separate care arrangements for dependents during work hours; continuous care responsibilities during shift times are not permitted

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Resources supporting physical, emotional, and financial well-being • Occasional travel opportunities for staff events