Utilization Management Nurse Consultant

Jobgether; United States; Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Fully remote

40 hours per week

Competitive base pay

Bonus eligibility

Benefits package

Job summary

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with providers and interdisciplinary teams.

The ideal candidate has 3+ years RN experience, ADN required with BSN preferred, and strong clinical judgment. This is a fully remote, 40-hour-per-week role with HIPAA-compliant security expectations.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum of 3 years RN experience.
• ADN required; BSN preferred.
• Strong clinical assessment and decision-making skills.
• Proficiency with Microsoft Office applications (Outlook, Excel).
• Able to work Monday–Friday 9:00–17:30 in local time zone with some flexibility.
• Experience in utilization management or prior authorization is preferred.

Responsibilities

• Review clinical documentation to make utilization management determinations using evidence-based criteria.
• Apply clinical judgment to evaluate medical necessity and support prior authorization decisions.
• Collaborate with providers and care teams to support treatment planning and care coordination.
• Ensure members receive appropriate care in the right setting and time.
• Identify opportunities to improve clinical outcomes and operational processes.
• Serve as a clinical resource for internal colleagues and external providers.
• Navigate healthcare applications to review documentation and manage cases.

Skills

Clinical assessment

Critical thinking

Microsoft Office

VPN access

Remote work

Education

ADN

BSN preferred

Tools

MedCompass

Microsoft 365

VPN tools

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Utilization Management Nurse Consultant based in Canada.

We are seeking an experienced Registered Nurse to join a remote Utilization Management team in a non-bedside clinical role. You will use your nursing expertise and evidence-based clinical criteria to review cases, assess medical necessity, and support appropriate coverage decisions. Working closely with healthcare providers and interdisciplinary teams, you will help ensure members receive the right care in the right setting at the right time. Your clinical judgment will contribute to effective prior authorization decisions, improved healthcare quality, and better member outcomes. You will also serve as a trusted clinical resource, helping stakeholders navigate complex cases and treatment planning. This opportunity is ideal for a detail-oriented nursing professional who wants to apply their clinical knowledge in a structured, collaborative, and quality-focused remote environment.

Accountabilities

• Review clinical documentation and patient cases to make utilization management and coverage determinations using established, evidence-based criteria.

• Apply clinical assessment skills and professional nursing judgment to evaluate medical necessity and support prior authorization decisions.

• Collaborate with healthcare providers and interdisciplinary care teams to facilitate appropriate treatment planning and care coordination.

• Ensure members receive appropriate care in the right setting and at the right time while supporting quality and safety standards.

• Identify opportunities to improve clinical outcomes, operational processes, and the overall member experience.

• Act as a clinical resource for internal colleagues, external providers, and other relevant stakeholders.

• Navigate multiple healthcare applications and digital platforms to review documentation, record decisions, and manage cases efficiently.

• Maintain confidentiality and comply with applicable healthcare privacy, security, and remote-work requirements.

• Work a regular Monday-to-Friday schedule, with flexibility to support occasional evenings, weekends, or holidays based on operational needs.

Requirements:

• Active, unrestricted Registered Nurse (RN) license in the state of residence, as specified in the role requirements.

• Minimum of 3 years of professional RN experience.

• Associate Degree in Nursing (ADN) required; a Bachelor of Science in Nursing (BSN) is preferred.

• Strong clinical assessment, critical thinking, problem-solving, and decision-making skills.

• Ability to interpret clinical information, apply evidence-based criteria, and make sound utilization management decisions.

• Proficiency with Microsoft Office applications, including Outlook, Teams, and Excel.

• Ability to work Monday through Friday, from 9:00 AM to 5:30 PM in the local time zone, with occasional schedule flexibility due to the 24/7 nature of utilization management operations.

• Previous experience in utilization management, prior authorization, care management, or managed care is preferred.

• At least 1 year of Medical-Surgical Nursing experience is preferred.

• Familiarity with MedCompass or similar utilization management platforms is an advantage.

• Ambulatory surgery or outpatient clinical experience is beneficial.

• Strong digital skills, including the ability to navigate multiple monitors, applications, calendars, email systems, and virtual meeting platforms simultaneously.

• Experience with Microsoft 365 tools, including Teams, Outlook, Word, Excel, and PowerPoint, or equivalent applications.

• Ability to securely access healthcare systems and applications, including VPNs, and follow established data protection procedures.

• Basic technical troubleshooting skills, including resolving connectivity and application issues, with a willingness to learn new technologies.

• For remote work, candidates must have a direct wired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite connections are not accepted.

• Must maintain a dedicated, private workspace that complies with HIPAA and applicable security requirements.

• Must be able to work from the confirmed state and city of residence and maintain the required internet speeds and remote-work standards.

• Company-provided equipment includes a computer, monitor(s), keyboard, and headset; employees are responsible for providing appropriate workspace furniture.

Benefits:

• Fully remote, work-from-home opportunity.

• Full-time schedule of 40 hours per week.

• Competitive base pay range of $29.10–$62.32 per hour, depending on experience, education, location, and other relevant factors.

• Eligibility for a bonus, commission, or short-term incentive program in addition to base compensation.

• Comprehensive benefits package, subject to eligibility, including:

  • Medical, dental, and vision coverage.

  • Paid time off.

  • Retirement savings options.

  • Wellness programs and additional resources supporting physical, emotional, and financial well-being.

• Company-provided computer, monitor(s), keyboard, and headset.

• Additional information about benefit options is provided during the application process.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.