Utilization Management Nurse Consultant – Behavioral Health

Description: • Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient services requiring precertification • Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information • Use established guidelines to authorize services or escalate to Medical Directors as needed • Navigate multiple computer systems efficiently while maintaining accurate documentation • Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills • Perform sedentary work with extended periods of sitting, frequent talking, listening, and computer use • Provide coverage for other UM Nurses across various UM specialty teams as needed • Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements Requirements: • Active, unrestricted RN license in state of residence with multistate/compact licensure privileges • Ability to obtain licensure in non-compact states as needed • Minimum 5 years of relevant experience in Nursing • Minimum 3 years of clinical experience in Behavioral Health and/or substance abuse including acute care, residential treatment center, partial hospitalization and intensive outpatient programs • 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: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost wellness programs (wellness screenings, tobacco cessation, weight management) • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job Apply To this Job