Utilization Management Nurse Consultant-1

For our client, we are seeking a Utilization Management Nurse Consultant-1 to join the team of a leader in the Healthcare space. This role will lead operational priorities where safety, quality, compliance, and execution discipline are central to success. You will collaborate with field leadership, support functions, and cross-functional stakeholders to improve accountability, service delivery, and operational consistency. The position offers the opportunity to influence operational scale, customer outcomes, and organizational performance within a healthcare environment.

Location: Remote - US based candidates only, no visa sponsorship available

Compensation: $108,000 – $155,000 annually

Responsibilities

• Utilize clinical experience to assess and facilitate appropriate healthcare services for members
• Gather clinical information to apply necessary clinical criteria for coverage determinations
• Communicate with healthcare providers to facilitate treatment and care
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult and provide expertise to constituents in utilization and benefit management

Qualifications

• 2+ years of experience as a Registered Nurse in adult acute or critical care setting
• Active and unrestricted RN licensure in state of residence
• Experience in Utilization Management's 24/7 operations, including weekend and evening hours
• Clinical experience in med surg or specialty areas preferred
• Managed care experience, especially in Utilization Management, preferred
• Associates Degree required; BSN preferred
• Preference for candidates residing in EST time zone

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and resources
• Eligibility for bonuses or incentive programs

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.