Utilization Management Nurse Consultant – MST/PST Zone

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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

• Review services for medical necessity and appropriate benefit use • Facilitate efficient discharge planning • Collaborate with providers and facilities to support members with complex needs • Assess, plan, implement, coordinate, monitor, and evaluate healthcare services and benefits • Collect and evaluate clinical information • Apply clinical criteria, guidelines, policies, and judgment to make coverage determinations • Communicate with providers and external partners to coordinate care and treatment plans • Identify opportunities for referrals to additional programs, services, or care solutions • Promote quality care delivery and effective benefit utilization • Serve as a resource to internal and external stakeholders regarding UM processes and clinical considerations • Coordinate, document, and communicate all aspects of the utilization and benefit management process • Ensure members receive appropriate levels of care while meeting state and federal requirements and turnaround times

🎯 Requirements

• Active, unrestricted RN license • 2+ years of acute hospital clinical experience • Strong preference for medical-surgical, ICU, behavioral health, or another specialty area • Strong clinical assessment and decision-making abilities • Excellent organizational skills and ability to manage multiple priorities • Ability to work independently and communicate effectively via phone • Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls • 1+ year of Utilization Review experience preferred • 1+ year of Managed Care experience preferred • Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook) preferred • Strong telephonic communication skills preferred • Demonstrated ability to exercise sound judgment and collaborate with diverse teams • Associate Degree in Nursing (ADN) required • Bachelor of Science in Nursing (BSN) preferred • Availability for Monday–Friday, 8:00 AM–5:00 PM CST • Weekends (12 per year) and holidays (1 minor and 1 major per year) required • 1 shift per month from 1:00 PM–7:00 PM; day may be chosen • Available to work from a U.S. state in the MST/PST Zone

🏖️ 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 • Other resources supporting physical, emotional, and financial well-being • No travel required