Nurse Utilization Review Consultant

4 days ago


Columbia, South Carolina, United States US Tech Solutions, Inc. Full time
About the Opportunity

We are seeking an experienced Nurse Utilization Review Consultant to join our team at US Tech Solutions, Inc. This role offers a competitive salary of $85,000 - $115,000 per annum, depending on experience and qualifications.

Key Responsibilities
  • Review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.
  • Utilize clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.
  • Perform medical or behavioral review/authorization process, ensuring coverage for appropriate services within benefit and medical necessity guidelines, and utilizing allocated resources to back up review determinations.
Requirements
  • A minimum of 4 years of recent clinical experience in a defined specialty area, including oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, or general medicine/surgery.
  • OR, 4 years of utilization review/case management/clinical/or combination experience, with 2 of 4 years must be clinical.
Our Company Culture

We value collaboration, flexibility, and innovation at US Tech Solutions, Inc. We strive to provide a supportive and inclusive work environment that allows our employees to grow and develop in their careers.



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